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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 /> , an~ perform,ng worR on a progerty, o~o~ eO~uRpyCODE-A'PHONE: 588-7904 .,...-// <br /> lama registered builder OR ()the authorized rep;esentative SIGNATURE OF APPUOANT~/ <br /> ) <br /> Other <br /> I have read and agree to the terms stated on the reverse side of DATE: <br /> <br />~ KEUDELL, LARR~ ~ Z~.~.:-~8~ RESIDENTIAL <br />j ~ITUB ADDRESS; ] CONSTRUCTION TYP~: ~ OCCUPANCY; <br /> <br />¢ 8400 SILVER FALLS HWY SE <br /> AUHoVit..LE OR 97;.,~ ~E~!~ COUNTY NO <br /> <br /> 1575 CAHBR];DGE I)R SE <br /> ~A[..E.M~ OR ~7~82 , SITE HU~BEE: ~4-81~17 <br /> PNONE~ .¢88',-,¢7~,4 VALUATION= <br /> <br />TYPE: B~ILDIW6 PERHIT OR APPLICATION <br /> <br />CONTRACTOR~ biO., 27217 <br /> ?et"ry L Cart Co~'mtruction I <br />1~7 Webster Dr SE <br />Salem~ ~7;J82-8~8~ <br />PHOhlE: 599-7598 <br /> <br /> ITEM <br />ADDITIONAL BUILDII,iG FEES <br /> <br />ARCHITECT/EMGINEER, NO. <br /> <br />PI4ONE: <br /> <br /> :.BALANCE DUE <br /> <br />PAYEE: Tm'fy [ Cart ConstruCtion <br />r ECE VE <br /> <br />TOTAL ASSESSED FEES <br />PRE¥IOU$ RECEIPTS <br />THI,S RECEIPT <br /> <br />QUANTITY AHOUNT <br /> $48.00 <br /> <br />$40.00 <br /> <br />$40.88 <br /> <br /> 62919 <br />TYPE: CK CHECK ~: 5215 <br /> <br /> ~ THIS irs NOT A PERNIT.,: TH'rS]APpL~TCATION]]'MU~:'GO THRouGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST BE COHPLETE~: IT~I8 THE APPLICANT TO ASSURE THAT <br />LL NECESSARY INFORMATION HAS ~EEH :PROVIgE9,: <br /> <br /> PLAN REW;EW, BY__ ] ]': : HEIGHT: <br /> ZONIMG: BY .... ' TOTAL SQ FT: <br /> SEPTIC: BY .................. ~ATET-'r--5-~ .... ~ STORIES: <br /> .................. ' .............. PLAH~ ACTION: <br /> CITY JUR].S~ICTION. BY_ Z ._2~ DATE ..... ENERGY BATN: <br /> <br /> REMARKS: $$Q$$ REVISION TO 588~8 <br /> <br /> SETBACKS: FR <br />0 L~ <br /> RS <br /> RR .............. <br /> <br />Oi=FfCE COPY <br /> <br /> <br />