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SENATOR BLDG, NO, 225 <br />220 HIGH STREET NE <br />SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:S0 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />[ am ~ registered builder OR the ¢,uthorized represen ~ ire <br />of a registered builder. <br />The work will be performed by a registered builder, <br />Other. <br /> <br /> '~2)~,(-T-~--AE'~-~Ii¢-~? ............ 0-~' ................ ~-"~'~A N l LOAD <br /> 915 8'tH <br /> <br />USE OF BUILDING; ~.'~'8~ROOMS ' · <br /> <br /> .... U3EL71-~Tf-%II .............................................. <br /> PO BOX 584 <br /> AOMSVII.,LE 0R 97325 SITE NUMBER: 94-1~22~2 <br /> PNONE: 749-$902 VALUATION: $27,000.00 <br />............ ....................... ........................ ...... ........... ......... ............ <br />~'~' [~: ' l~" 7--~ ...... ~-~ ........ ~,~ ................ ~ .................. <br /> 7~ '.~-~-~~.,-,~ ,.,, ..... ~ ..... : ......... ~ ................ <br /> <br />TYPE~ BUILDIN6 PERHZT OR APPLICATION <br /> <br />COFII'~AC'rO~ NO. 61474 <br />[.~rry. P I',.oeniq <br />· ~4~& 72'r~d Ave SE <br /> <br />PHONE: 585-8884 <br /> <br /> ITEM <br />BUILDING FEE <br />PCAN REVIEW <br />BUILDING STATE SURCHARGE <br /> <br />ARCHITECT/ENgINEER, <br /> <br />PHONE: <br /> <br />QUANTITY AMOUNT <br /> <br />PAYEE~ Larry P Kom~ig <br />REC~[IVED BY: PB <br /> <br /> * THIS IS HOT A PERHI1 <br />FOLLOWING HUST BE <br /> LL NECESSARY iNFORHAT; <br /> <br />PI_AN REVIEW: <br />ZOI,IING: BY <br />oEPItC, BY <br /> <br />C :I:'I'Y JURISD:r, CTI014: <br /> <br />R~i:MARKS: BDRM/QEN/FAW RM:,,,ADDFI <br /> <br />TYPE,., <br /> <br /> 800 <br />1 <br /> <br />$17~. 50 <br />~,.I, 16.68 <br /> $8.98 <br /> <br />$~05,, I6 <br /> $0.00 <br />$305.16 <br /> <br />$0,00 <br /> <br /> 58118 <br />IN CHECK '~: 0 <br /> <br /> PROCESS WHERE THE <br />~ANT TO ASSURE THAT <br /> <br />SETBACKS: <br /> <br />F'R <br />I.,,S"-5 <br />RS"5 <br /> <br />FORM # MO 15-56 REV, 4/90 OF FICE COPY <br /> <br /> <br />