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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 of~ a property I own or occupy. <br />lamareglsteredbuilderOR( ) the authorized representative <br />of a registered buiMer, <br />The work will be performed by 8 registered builder, <br />Othor <br /> <br />I have read and agree to the terms stated on the reverse side of <br />this doGument. <br /> <br />,oW~~D~TF__J6771J/?4 'TIME':" :[,~: ,7:1:~ 41 i TAX LOT; :CATEGORY: <br /> <br /> ~¢tU¢ ,X~¢J~DE~sE.,'RN,. gUZL~ZNG SYSTEMS, ........... : c~¢A~¢~W~ ;COMMERg~occu~,~c,: ~L <br /> <br /> i',~TRACT CITY: ~PAN'f LOAO: <br /> ?493 POR~ER RD ~:.SE I ' <br /> <br /> OEF ICE, BAN AND · ~F~F~.SSI~XA[ ~I~BI NL;,S <br /> <br />KENIIEIH A RASMUSSEN,~ P.E. 682-;L422 <br />F'O BOX 258 TUAL. ATIN~ OR 9?062 SITE NUMBER: ?4-82749 <br />F'HON[~: 74~'-4~4~ VALOATION: $1 <br /> <br />TYPE: BUILgIHG PERHIT OR APPLICATIUN HO: <br /> <br />CONTRACTOR,~ NO~ , <br />NODDERN BUILDING oY. TEMS~ IN <br />KEHNETH A RASMUSSEN, P,E. 68 <br />PO BOX 256 TUAL. ATIN, OR 9766 <br />PHONE: 749-4949 <br /> <br /> ]:TEN <br />BUILDING FEE <br />PLAN RE¥IEW <br />BUILDING STATE SURCHARGE <br />ZONING SURCHARGE <br /> <br /> 47~74 <br />ARCHITECT/ENGINEER, <br /> <br />PHONE: <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />TH[$ RECEIPT <br /> <br />BALANCE DUE <br /> <br />NO · <br /> <br />QUANTITY AMOUNT <br /> $23,56 <br /> $15.28 <br /> $1.18 <br /> $1.18 <br /> <br />$41.14 <br />$41.14 <br /> $0,,60 <br /> <br /> PAYEE: <br /> RIECEIVED BY: DM ....................................... 'TYPE: CHECK ~: 0 <br /> <br /> ~ THIS IS A VALID PERMIT..THIS PERHIT EXPIRES'IBC DAYS FROH ITS ISSUE DATE. IF <br />CONSTRUCTION CEASES FOR A PERIl]i) SF,,18¢ 9AYS~ OR IF CDH~TRUCTION FA~LS TO NEET ALL <br /> ~LL ~ECOHE NULL ~HD VO~D~ <br /> ~ HEIGHT. ~ETBACKS: FR <br /> ' TOTAL SQFT: e LS ......... <br /> ENERGY PATH: STORIES: RS .......... <br /> PLAN. ACTION: RR ....... <br /> <br /> REMARK,:. M6DOLAR BLD6 SY~TE~S (OFFICE 144BSQ FT ~EXT TO EXI=TING OFF) <br /> <br /> DCNALD E, WOODI...EY, MARION COUNTY,BUILDiNG OFFICIAL / BY ............................................................. <br /> <br /> OFFICE COPY <br />FORM # MC 18,58 REV. 4/90 <br /> <br /> <br />