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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: 588-8147' 8:00- 4;30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />lam a registered builder OR( )theauthorizedrepre~entative <br />of a registered builder. <br />The work will be periormed by a registered bullder. <br />Other <br /> <br />I hsve read and agree to the terms stated on the reverse side of <br />this document. <br /> <br />TYPE: ~WEL.L]I~G PERMIT OR APPLICATION <br /> <br /> 1 'T L' N <br />I)WELI [,, ~}:/I/;J,,DIHG FEE <br />DMI, .i. IHE; <br />DWELLING ~ECHAN II;AL <br />DWEL L~hI¢ Et.b .,lf(] <br /> <br />DWELI,.IH(; F'LAN kE~ <br /> <br />PHONE: <br /> <br />'TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY <br /> <br />$705.96 <br />~705.96 <br /> <br />;BAI..I~NCE DUE $f6,, 00 <br /> <br /> I'-Af:.,:. JohD F kzet:h,,r <br /> RI.,CEI~LD }Y,, H ............................................................ TYPE= IN CHELk ~ <br /> <br />~ THIS ~fi NOT A PERMIT. THIGi APPLICATION HUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST ~ CONPLET~. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> LL NECESSARY INFORMATION HAS ,BEEN PROV~DE~. <br /> <br />CJ'TY JUF;~.)JCf Ot,,, m DATE <br /> <br />HEIGHT: <br />TOTAL SQ :T: 1772 LS"5 <br />STOR;[ES: <br />F'LAN. ACTION: PR'"14 <br />ENERGY PATH: t SF"~'~,. , <br /> <br />OFFICE COPY <br /> <br /> <br />