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MARION COUNTY BUILDING INSPECTION <br /> <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br />SALEM, OREGON 97301 <br /> <br /> PHONE: 588~514.7 8:00 - 4:8,0 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I ,~m performing work on a property I owrl or occupy. <br /> <br />of ~ registered builder, <br /> <br />I have read and agree to the terms stated on the reverse side of <br /> <br /> OWNER; ; TAX LOT: CATEGORY; <br /> HAf~StlAL[.~ C¢I.,.V I N 90080-285 RES:[DENTIAL <br /> <br /> 5.'"N <br /> AO~GVILLE OR ~7~25 AUMSVILLE ~ NO I <br /> ~)LIF L[,,X 4 <br /> <br /> 5494 HARZOIq HILL R~ <br /> FHONE: 769-~:,97 VALUATION: $85, 689.80 <br /> <br />WIDTH; :DEPTH'. AREA; , UNITS: i fRREG. LOT'. CORNER; <br /> i08 5¢; 5400.: : NO <br /> <br />TYPE-- D~ELLING <br /> <br />ARCHITECT/ENGIWEER,~ NO. <br /> <br /> ITEM <br />DWEI. LiNG BUlL. DING FEE <br />DWELLING PLUMBING <br />I)WEL L]:NG MECI, IAI,IICAL <br />I)WELLIN(,; ELECTRICAL. <br />DWELLING STATE SURCFARGE <br />DWELt. lNG PLAN REVIEW <br /> <br />PHONE: <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY <br /> <br />AMOUNT <br /> $270,,S1 <br /> $98.57 <br /> $24.56 <br /> $76.97 <br /> <br /> $185.88 <br /> <br />$678~93 <br /> $0.00 <br /> <br />WEIGHT: <br />TOTAL SQFT: <br />STORIES: 1 <br />PLAN. ACTION: <br />ENERGY PATH: 1 <br /> <br />BALANCE DUE <br /> <br /> $0.00 <br /> PAYEE: CALVIN ~. NARSNALI. <br /> -,ECE,[VI:,Q BY: PM ..................................... TYPE: IN CHECK ,~: <br /> <br /> ~ THiS IS HOT A PERHIT. THIS APPLICATION HUST CO THROUGH A REV~E~ PRDCESS WHERE THE <br />iFOLLO~ZN6 ~UST 9E CO~P~TEg, ~T ~S THE RESPONSIBILITY OF THE ~PPLZC~HT TO ~SSU~E THaT <br />LL NECESSARY [NFOR~TZON HRS ~EEN PROVZ~E~. <br /> PLAN REVIEW. BY ~ATE--' SETBACKS: FR <br /> ZON~NG: BY .............. DATE .................. 1&88 L S'"'8 <br /> <br /> RR'"'B <br /> ~F']'. ......... <br /> <br />CITY JURISDICflON: BY DATE <br />, RI,.HARK.. BUF'LE'X <br /> <br />.e~ ~ VG t ~-~ ~v. ,~mo OFFICE COPY <br /> <br /> <br />