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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: S88-7904 <br /> <br /> Am performing work orl a property I own or ~cupy, . · <br />I am a registered builder OR ( ) the authorized represen a ive SIGNATURE O~ ARPUCANT <br />of a registered builder. <br />The work will be pedormed by a registered builder. <br />Other_ <br />I have read and agree to the terms stated on the reverse side of BATE: <br />this documen[ <br /> <br />OWNE~: i)h'tE'~ 04/14/94 <br /> I-(,tlK, TF, E~ FRANK <br /> SITUS ADDRESS: <br /> <br /> A.IRO,.,A I:IR 97002 <br /> <br /> L "' Jr(AL S'[~ JCT.IF:ES <br />MAI~.ING~,~ ADDRESS: ~ <br /> 4'J. 9~ VAN WELJ.,. RO <br /> DAi,,.LAS,~ ?R 97~;(I <br /> PHONE: 62~'-3692 <br /> <br />LOT: BLOCK; <br /> <br />C'dN~ACl' CifY: : U~B: <br /> <br />TAX LO~ : <br /> COM~I[~F(CI AL <br /> <br />SITE NUMBER: 94-'8144[' - <br />VALUATION: '~227 ~ 880.00 <br /> <br />TYPE: BUILBING PER~IT DR APPLI6ATISN <br /> <br /> t T E M <br />BU]:L,D i Nf_; FEE <br />PL,.AN RL':¥ I EW <br />BU:[L.D];N6 STATE SURCHARGE <br />ZSNING SURCHARGE <br /> <br />ARCHI TECT/EN61NEEI~,~ <br /> <br />PHONE: <br /> <br />TOTAL AS,.~E,~E:O FEES <br />PRI,.TV I OUS RECEIPTS <br />THIS RECEIPT <br /> <br />BAL_AN(.;F; DUE <br /> <br />QUANTITY <br /> <br /> AMOUNT <br /> $75S.00 <br /> $4S9,,45 <br /> <br /> $S7..65 <br /> <br />$1~S17.75 <br /> $0.00 <br /> <br />56671 <br /> <br /> REF. EIYFD BY: Fq'i TYPE: Ci~; CHELk f-: S,¢,~. <br /> <br />* THIS IS HOT A PERMIT. THIS APPLICATION HUST 60 THROU6H A REVIEW PROCESS WHERE THE <br />FOLLOWIH~ MUST BE COHPLETED. !IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> LL NECESSARY INFORMATION HAS BEEN PROVIDED, <br /> <br />SEPTIC: ~Y ........................... ., ..................... <br />CITY ,J <br />~?I:;HARKS: A[', ~;I'C)R BL.I)6 FOR HAY <br /> <br /> HEIGHT: <br /> ,..; ~ ACKS. ER "'-' <br />TOTAL SD FT: ~* LS'-'';~ <br /> STORIES: ~ , ~:,' !:~ '"~" <br /> PL..AN. ACTION: RR '" -""'~ <br /> ENER6Y PATH: 9P <br /> <br />OFFICE COPY <br /> <br /> <br />