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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: 588-7904 <br /> <br />I am performing WOrK on a property I own or occupy, <br />I am a registered builder OR the authorized representative <br /> of a reglstered builder, <br />The work will be performed by a regiatered builder, <br />Other <br /> <br />this document, <br /> <br />75~.~i D!~ ~ .... <br /> I TAX LOT; ; ~TEGORY; <br />ltCl:rLFi:,~ WAYNE; , RESIDENTIAL <br />~i~U~ ~dbA'~§§F ~ CONSTRUCTION TYP~; OCCUPANCY: <br /> u-Il <br /> AU .,~V [~._~ .... OR 97325 ', At.iNS V I L.~..[~: <br /> USE OF ~UILDING'. <br /> RI:'SiDENT"A] ACCESSORY ~ FkUE, fU <br /> <br /> SITE NUN~R~ <br /> F'HONE~ 76'2..-774,4 VALUATION: <br /> <br />LOT: ~ BLOCK: ~ SECTION; ! TQWNSHSP; RANGE: ~ ZQNE'. MAP; <br /> 126 ~ 6~S~. j <br /> <br />TYPE= 8UZLDING PERNtT OR APPLICATION NO: <br /> <br />ARCHITECT/EhICINEER~ f-lO. <br /> <br />PHONE= <br /> <br /> :l TEM QUANTITY AMOUNT <br />~4U t:U')ING FrEE $3;3,, 50 <br />PLAN REVIE'W $25. <br />~'d. JZI,.~)IHG STATE SURCHARGE ~,~:I,. 93 <br /> <br />TOTAL A~$ESoED FEES <br />PR£VIOU.~ RECEZF'TS <br />THZ8 RECEIPT <br /> <br />$6. ,, 46 <br /> <br />PAYEE: <br /> <br />BALAHCE DUE $~),, ¢/,~ <br /> <br />:il, ,(~Y F'ATH= <br /> <br />?,d! !'iAf,'KF,: <br /> <br /> · - I'YF E, Ch.:O'( 8 <br /> * THIS IS fl VALI~ PEEHIT. THIS PERNIT EXPIRE~ 188 ~AYS FROH iTS ISSUE ~ATE. IF <br />CONSTRUCTION CEASES FOR A PER~O~ OF 188 DAYS~ OR IF CONSTRUCTION FAILS TO NEET ALL <br />EBUIRE~ENTS OF STATE ).~S ANQ HARIOH COUNTY BUIE~ING AN~ ZONING ORDINANCES~ THIS PER~ZT <br /> ALL BECQME NULL AN~ VOtg'. ' ~ <br /> HEI:OHT: SETBACKS: F:i:~ ~g <br /> TOTAL SQ FT: ~88 LS .... <br /> STOR]:ES~ RS' '& .... <br /> <br /> ENERGY F'ATH: SP" <br /> <br />~ );I,!A' l> '~ U)fZl)l...,]A¢ /4,6, R;ZON '%)Ui*ITY BO;;:.I.,,i)INI; OFF'[CIAL / BY .......................................................... <br /> <br />OFFICE COPY <br /> <br /> <br />