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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 e property I own or occupy, <br />I 8m e registered builder OR the authorized representative SIGNATVR6 OF APPLICANT'. <br />of a registered builder, <br />The work will be pedormed by a registered builder. <br />Other <br />I have reed end agree to the terms stated on the reverse side of DATE; <br />this document, <br /> <br /> .~24 ~SPEI*1 DR ~- 14 <br /> A.U,._~_8_Vj_, !,_l. g .................... ~R ?-~2,~ <br />UgE OF BUILDING'. <br /> <br />2216 SE ~01'H <br />AI,.BANY, OR 77~21 <br />PHONE: 926-6454 <br /> <br /> [ NO. OF BEDROOMS: <br /> <br />BU gDIVI$1ON: <br /> <br />...... 'f,tT. L%- -'61~--E $ TPi'TE'S ......... <br /> <br />SITE HUHBER= <br />VALUATION: <br /> <br />CONTRACTOR~ NO. 9894~ ' ARCHITECT/EhIG~NEE~ NO. <br /> Capitol AwniDg : <br />~18 Vgile~wood'Dr SE ~ <br />PHONE: ~8~-,1711 PHONE: <br /> <br /> ITEM ~::~, ; QUANTITY <br />BUILDING FEE <br />PLAN ~EVIEW :: <br />BUILDING STATE <br /> <br />PAYEE: FROM PERMIT:~ <br />RECEIVED BY: CL <br /> <br />LL NECESSARY IHFORHATI( <br /> <br />PLAN REVIEW: .BY <br />ZONTNG: BY <br />SEPTIC: <br /> <br />CITY JURISDICTION: BY <br /> <br />RE,lARKS: CARPORT ADDENDUm? <br /> <br />600 <br /> <br />AMOUNT <br /> $56,,50 <br /> $36.73 <br /> $2.83 <br /> <br />$95.06 <br /> $0,,08 <br />$38.50 <br /> <br />$57.56 <br /> <br /> 58iJ0 <br />CHECK ~: 0 <br /> <br /> PROCESS WHERE THE <br />.ICANT TO ASSURE THAT <br /> <br />SETBACKS: F'R :tO <br /> LS'"'/ <br /> RS'"'6 <br /> RR'"':L 0 <br /> <br />FORM # MC 1 ~,~6 R~W, 4/90 OFFICE COPY <br /> <br /> <br />