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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97;301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am a registered builder Om ( } the autl~orlzed representative SIGNATMRE OF APPLIC <br /> <br />HOEKSTRE~ FRANK I CO~HERC](AL <br /> <br /> 11~23 EHLEN R0~D NE CONTRACT CITY; UGB'. OCCUPANT LQAD: <br /> ~0RORA OR 778e2 '.H~RZON COUNTY ~N0 ~ <br /> <br /> STRUCTIJRES OTHER I'H~N 8UILDIN6S <br /> <br /> VAN NELl, RD " ~"j"O'OO <br /> DAI..L.A-S~ OR ?7338 ~ SITE NUNBE~: 94-~144B <br /> PHONE~ 623-S692 VAI_tJATION: ~ <br /> <br /> ~, i 18, ;: AC NO ND <br /> <br />TYPE: <br /> <br />CON ~'RAC TOk~ NO'. <br />HOE'-KS £RF,~ FRANK <br />4190 VAN WELL RD <br />DALLAS,~ OR ~'?~8 <br />PHCINEi~ <br /> <br />PERNIT OR APPLICATION NO: 9054972 <br /> ARCHI'TECT/EN~;~NEER~ NO. <br /> <br /> PHONE: <br /> <br /> Il'EM QUANTITY AMOUNT <br /> BLI];I.~ING FEE $44.~6 <br /> PLAN REVIEW $28.93 <br /> 84./ZL~IN~ $1'AT~ SURCHARGE $2,,2~ <br /> ZONING SURCNARGE $2.2~ <br /> <br /> TOTAl_ ASSESSED FEES <br /> PREVIOUS RECEIPTS $8.08 <br /> $77.89 <br /> <br /> PAYEE~ HDEKsI'RE~ FRANK ~__...---'"' 57444 <br /> RECEliVEB By: PM ..................................... g:&_--~___ TYPE: CE CHECK ¢: 3687 <br /> <br />* THIS IS NOT A PERHIT, THIS APPLICATION HUST GO THROUGH A REVIEM PROCESS MHERE THE <br />FOLLONiHG HUST 9E COHPLETED,.ZT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> LL NECESSARY INFORNAT[ON NAg BEEN PR~ZDED. <br /> <br />HEIGHT: <br />TOTAL S/.} F')": <br />STO R I ES: <br />PLAN. ACTION: <br />ENERGY PATH: <br /> <br />~o$~* ~c ~s-~ ne~, ,mo OF FICE COPY <br /> <br /> <br />