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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 />OtherThe work will be ,Perf°rmed by a registered builder. <br />I have read and agree to the terms 8tared on the reverse sMe of BATE: ~ ~'- <br /> <br /> &i"IIGLIERI ~ LDR[.NZD <br />SITUS ADDRESS'. <br /> <br /> .4034,~-000 <br />' CONSTRUCTION TYRE'. <br /> <br />CATEGORY; <br /> <br />RESIDE-NTIAL <br />OCCUPANCY: <br /> <br />;USE OF BUILDfN~: <br /> <br /> ~¢~ , SiTE NUMBER: 94-01779 <br /> <br />JW DTH~ <br /> <br />I <br /> <br />:DEPfH: <br /> <br />TOWNSHIP; ' RANGE'. EONE: ; MAP: <br /> <br />TYPE: DWELLING PERMIT OR APPLICATION <br /> <br />C, ONTRACTE}R,, NO. <br />GHI.Fd..IER;( ~ I,,,OI~ENZO <br /> <br /> 985478~ DP <br /> <br />Al:U-;MI TECT/EN G;[NEER~ NO,. <br /> <br />PHONE: PHONE: <br /> <br /> I'FEN <br />DWEIi,,I,,.ZI,II; BU:[I.,DII,II;; FEE; <br />DWEI_LIN6 F'I.UHBINt; <br />~EI,,LZI4G HECN~NZ6~I_ <br />DWELLING ELECTRICAL <br />DWELt. IN6 STATE SIJROHARGE <br />DWELLINg PLAN REVIEW <br />DWELLING 'ZONINO SURCHARGE <br /> <br />D?YEE: GFIIGLIERI~ LORENZO <br />RECEIVED BY: PN <br /> <br />QUA hiT ]: T Y <br /> <br />AMOUNT <br /> $847.,45 <br /> $309,. 82 <br /> $76 ,, 99 <br /> $241.30 <br /> $7¥. 74 <br /> $185.00 <br /> $:1,5.0~ <br /> <br />:''TOTAL ASSESSED FEE:S $1,741i1,,50 <br />PREVIOUS RECE ~. F"IFS <br />: .T~' XS RECEIPT ~1,748, <br />BALANCE <br /> <br /> $0.. <br />',5'7236 <br /> <br /> TYPE= CK CHECK ~: 'i0,.~¢.='~' '~,91 <br /> ........................... ]~]~2~-i~=~:-~_=-~ ................................................................................. <br />* THIS I8 i~T A PERMIT. THISAPPLICATIOMflUST GO THROUGH A REVIEW PROCESS WHERE THE <br />F8LLOBIMG MUST ~E COMPLETED. IT'iSTHE RESPOMSI~ILIT¥ OF THE APPLICANT TO ASSURE THAT <br />LL NECESSARY IHFORNATIONNAS:BEEHPROViDE~.. <br /> <br />CI'fY ,JURiSDIC'FION: BY DA'rE..................... <br />REMARKS: HEW RE:S, SS-'" ............. <br /> <br />TOTAL SQ FT: <br />STORIE~: 2 ~ % ~-~ ~ "-'"~'~ <br />PLAN. ACTION: / Rm~""-~';' <br /> <br />FORM # MC l S-56 REV. ~/80 OF FICE COPY <br /> <br /> <br />