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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 ,sm performing work on a property I own or occupy, <br />I am a registered builder OR the authorized representative <br />of a registered builder, <br />The work wlH be performed by a registered bullder, <br />Other , ,, <br />I have read and agree to the terms stored on the reverse side of <br />this document· <br /> <br />i ...................................~ ............ ,AC ............. :-NO ............. 0 <br /> <br />;dWNER:DATE: 07708794 TINE: 8::~4~,27 fax Lo'fl :CATEGORYr <br /> <br /> ') , . i,,C~TRAOT CITY: [ UGB: : ~PANT LOAD: <br /> 1~93 EHLEN RD NE ' <br /> AURoBA __~ ~7¢,~2 ~0 <br /> <br /> S.INGLE FAMIL~ DWELLI~F~S <br /> <br /> (~ / ~ SITE NUHBER: <br /> PHOI,IE: ff _ ~ VAI_UATION~ $298~899. <br /> <br />YYPE: D~ELLING PERHIT OR APPLICATION NO; 9a54783 DP <br /> <br />60NTRAETOF~ NO. ARCHZTECT/ENGTNEER~ NO. <br />GH'rGLIER'r ~ t_OREI,IZO <br /> <br />PHONE: PHONE: <br /> <br /> ITEM <br />DWELL. lNG BUILDING FEE <br />DWELt. lNG PLOMBING <br />DWELLING HECHANICAL <br />DWELLING ELECTRTCAL <br />DWELLING STATE $1JRCHARGE <br />DWELLING PLAN REVIEW <br />DWELL~'NG ZONING SURCHARGE <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />]:HIS RECEIPT <br /> <br />QUANTITY <br /> <br />ANOUNT <br />$1,029.,75 <br /> $375,,4~ <br /> $93,,55 <br /> $29~.21 <br /> <br /> $~S5.00 <br /> $15,.09 <br /> <br />$2,081.~0 <br />$1~748,,J0 <br /> $0.00 <br /> <br /> PAYEE: <br /> RECEIVE~ BY: DM ........................................... TYPE: CHEGK ,l~: 0 <br /> <br />8 THIS IS NOT A PERNIT. THIS APPLiCATION'HUST 'gO THROUGH A REVIEW PROCESS ~HERE THE <br />FOLLOWING HUST BE COHPLETE9. I~ IS THE RESPONSIgILITY OF THE APPLICANT TO ASSURE THAT <br /> <br />LL NECESSARY INFORMATION H~SBEENPRO¥I:DED.: <br /> <br /> PI_AN REVIEW: BY DATE <br /> ZONING: BY ............. DATE <br /> <br />CITY JI!RISDIC'TION: BY DATE <br />REHA~IiS: NEW RES, SS ........................ <br /> <br />OFFICECOPY <br /> <br />FORM # MC 1 G.56 R~. 4~90 <br /> <br />HEIGHT: ~.,~,,.~q~ETBACKS. FR 20 <br />TOTAL Sa FT: ~i~:PJO~:;/" LS'"'10 <br />STORIE~: 2 RS" :1.0 <br />PLAN~ A6TION: RR'j'.38 <br />ENERGY PATH: 1 SP <br /> <br /> <br />