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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 888-7904 <br /> <br />I am a registered builder OR ( ) the authorized representative '~y ~ ~SIGNATURE <br />this document. <br /> <br /> --. *=;, ' i CATEGORY: <br />OWNE,: DATE: 0312~.~94 ;rZHiL('i'Sii._':'O? T~X C~ <br /> <br /> 32¢ BUTTE ¢1 N- <br /> <br />MAIt,JNG ABORE~';%Ij)E'HTIAL AC[~E;;,,~OR¥..$¥RIJ&I'Uk-E~ ..... SUBDIVISION; <br /> <br /> ..... HAMMON:O' ADDI'T):ON ....... <br />5822 I. IBERTY RI) SE <br />SAI. EH. OR 973~6 SITE HUMBER: 94-~1204 <br />PHONE~ 362-3822 : VALUATION: $~848.88 <br /> <br />TYPE: BUILDING PERMIT OR APPLICATiOH NO: <br /> <br />CONTRACTOR, NO. <br />PRODZIFISKZ. R W <br />5822 LIBERTY RD SE; <br />SAI..EM~ 0R 97~06 <br />PHONE: ~62.~022 <br /> <br /> Il'EH <br />BUlL, DING FEE: <br />PI. AH REVIEW <br />BUILD:IH6 STATE SURCHARGE <br /> <br /> 7053782 <br />ARCHZTECT/ENGIHEER~ <br /> <br />PHONE:: <br /> <br />TOTAL. ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />BALANCE DUE <br /> <br />NO. <br /> <br />QLIANTI'[Y AHOUNT <br /> $44.50 <br /> $28.93 <br /> $2.23 <br /> <br />~75.66 <br /> $0.00 <br />$75.66. <br /> <br />$0.0¢ <br /> <br /> , AYEE. FRODZ.[FI,~K.£~ R W 56252 <br /> RECEIVED BY: Phi.,__2 ............................................. TYPE: IN CHECK 4,: 0 <br /> <br />* THIS IS NOT A PERMIT. THIS APPLICATION ,MUST GQ THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING ~UST BE CONPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> LL NECESSARY INFORNATION HAS BEEN PROVIBEB. <br /> <br />PLAH <br /> REVIEW: <br /> ....... "'" '"" ..... DATE' ............ <br /> <br />C fY ,JURISDICTION: ~Y ............ DATE <br />REHARKS: STORAGE SHE~ <br /> <br />HEIGHT: SETBACKS: FR 20 <br />TOTAL SQ FTc 320 LS 5 <br />STORIES: I RS 5 <br />PLAH.ACTION: RR-:L5 <br />EHERCY ~ATH: SP'] ...... <br /> <br /> OFFICE COPY <br />FORM # MC t 5.56 REV. 4/90 <br /> <br /> <br />