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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: 588-7904 <br /> <br /> I am performing work on a property I own or occupy, <br /> I am a registered builder OR ( ) the authorized representative SIGNATURE OF APPLIOAN'-: <br /> of a registered builder, <br /> The work will be performed by a registered builder, <br /> Other <br /> I have read and agree to the terms stated on the reverse side of BATE'. <br /> this document. <br /> <br />SITUS ADDRESS'. ' CONSTRUCTION TYPE; ,' OCCUPANCY: <br /> S"N ;M.-I <br /> <br />F'HflI'E: ~%-.,¢1223 ~ VALUATION: <br /> <br />TYPE: BIIIL])ING PERMIT OR APPLICATION NO: <br />I';rlt,q'~sl::Trlr~.F' ~lo. ~ q I,.~ ¢ ~ <br /> <br /> I'rEM <br /> <br />?[,~N RE'V]:EW <br /> <br />ZO'itl4E SL RCI-IA~E <br /> <br /> ~057572 <br /> <br />AR,nH,[ TECI/:,NE~,~,FJ, B~, l'tO. <br /> <br />PHONE: <br /> <br />(l U A Iq T l T Y <br /> <br />TOTAL, ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />~;98.,50 <br />$64,,03 <br />$4,.93 <br />$4,,9~ <br /> <br />~d. 72,, 39 <br />$0. <br />$172,, 3? <br /> <br />BC~[mNCE I)UE !~). 08 <br /> <br />~shYE~i:: .ION RUSSi[Nt; t,~ ISI <br /> <br /> 600?6 <br /> l'¥r:'E: CK Ci,,~ECi~ ~k i'74~ <br /> <br />* TNZS IS NOT A PER~IT. THIS ~PPLZCATZON HUST EO THROUCH A REVZEW PROCESS WHERE THE <br />FOLLOWING H~ST BE COMPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> LL NECESSARY INFORmATiON HAS BEEN PROVIDED. <br /> <br />TOTAL SQ FT: I440 <br />STORIE~: z F(S Z~~ <br />Pt AN. ACTIOd <br />ENERGY PATH: m". <br /> <br />PORI~ 8 MO 15-56 REV. 4190 OFFICE COPY <br /> <br /> <br />