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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: 588-7904 <br /> <br />of a registered builder. <br /> <br />I have read and agree to the terms stated on the reverse side of <br />this document. <br /> <br />I........... ~i~'A I i-H~. DONN¢~ ......... ....... R E S;[ D,~N 'f' I A L <br /> SITUS A~DRESS'. ' ~ OONSTRMCTJON TYPE: ~ OCCUPANCY: <br /> <br /> AUHSV~;U,.E OR ~77~5 [ AUNSVILLE ', NO <br /> ~ b-¢--~O E'b k~ ............................................. ~ ~o~0¢ SE~,oo~s~ <br /> <br />2493 LATONNA <br />PMONE: 398'"'78~9 VALUATION: $68,298. <br /> <br />TYPE: DWELLING PERMIT OR APPLICATION NO: <br /> <br />DWELL]]~6 BUILD]'NG FEE <br />bWEI..L I N~; PLUNB];N6 <br />DWFL L]'NG MECHANICAL <br />DWEI_L~NG EI.,ECTR,~CAL <br />DW~;Lt,.ING STATE SURCHARGE <br />~WELL_~NG PLAN REVIEW <br /> <br />FAYEL,, <br /> <br /> 53911 DP <br />ARCNITECT/ENGZNEER~ NO. <br /> <br />PHONE: <br /> <br />TO,TAL' A!!SESSED FEES <br />'PRE~IOUS RECEIF'TS <br />THIS RECE]:PT <br /> <br />;aALAII .E DUE <br /> <br />LIUANI' I'f'y <br /> <br />AMOUNT <br /> $265., :L6 <br /> $96.69 <br /> $24. <br /> $7% 50 <br /> $23. ~7 <br /> $185,, (~0 <br /> <br />$6~9,,51 <br />$669,.5t <br /> $8,,00 <br /> <br /> RECE!VEO BY'.: PI~ TYPE: CHECK ~J~: 0 <br /> <br />CONSTRUCTION CEASES FOR A PERIO~ OF 180 SAYS, OR. IF CONSTRUCTION FAILS TO ~EET ALL ALL BECBME NULL AH~ VOID. : <br /> . HEIGNT. SETBACKS: FR 2~ <br /> ~OTAL 8Q FT: i648 LS'"2¢ <br /> ENERGY PATH: ' STORIES: 1 ,o.. :- <br /> PLAN. ACT2ON~: PR"-5 <br /> ENERGY F'ATH: 1 SP"- <br /> <br /> ?,)i,iA;.D I:.;, ~O{}~L,~EY~ HAR'[ON COUNTY BUILQING OFFICIAL / BY ~ <br /> <br />FORM # MC 1~-~6 REV, 4/~ OFFICE COPY <br /> <br /> <br />