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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />2PO 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 perfoPming work on 8 property I own or occupy, <br />I &ma registered builder OR ( the authorized representative <br />of a registered builder, <br />The work will be berformed by a registered builder. <br />Other <br /> <br /> ~]:LL CREEK ESTATES <br /> <br /> ~;,,, ' :,, ~ S~TE ~UMBER: <br /> , HOHL 769,,,7744 ~ VALUATION~ <br /> <br />Edf: ....... ~ BLOCK; m SECTmON: ~' TOWNSHIP; ~ RANGE ~ ZONE'. ...... <br /> <br />TYPE: BU[LBING PERH~T OR APPLICATION NO: <br /> <br />BLt:~ £,I):i;I,~(; FFE <br /> REVIEW <br />BU:I:LI)};I,IG STATE SURSHARAI!' <br /> <br />AEC?il T£cT/ENg, Z NEER ~ <br /> <br />PHONE: <br /> <br />TOTAL AS.E.~SED FEES <br />PREVIOUS RECE]:PTS <br />THIS RECEIPT <br /> <br />NO,, <br /> <br />QUANTITY <br /> $~8,,58 <br /> <br />,BAL.ANCE DUE '~F.~. ~,3 <br /> <br /> i.'AYFF: ,O¢.L Hcl.,~o¥'r4i :k 571~2 <br /> RF' ;E].V~ D BY:; F'H ............................................................. TYF'E~ IN CHECK ~4 8 <br /> <br /> ~ THIS 3S NOT A PER~IT. THIS ~PPLICATION ~ST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOi. LQW~NG MUST 3E COHPLETED. , iT IS THE RESPONSIBILITY OF THE APPLZCANT TO ASSURE THAT <br /> LL NECESSARY INFORMATION HAS BEEN PROVIDED. , , <br /> <br />300 <br /> <br />.i,F.,1BA~.,KS. FR 10 <br /> HR' 1 ~ <br /> <br />FORM ~ MC ~-58 BEV. 4/~ OF FIC E COPY <br /> <br /> <br />