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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 />The work wilt bo performed by e registered b~ilder, <br /> <br /> OWNER~) ¢:'t']' I' ~t)//:[ ~i. J9 4 ' 't' Z I~ I:~: '" :['~ ~'~: ~,'." 5'~ .... ' YAX LOT 'OATEGORY: <br /> <br /> ~ ' ~Nq ":~ <br /> <br /> AUMSVILL. E OR R7525 ~UMSVIL, LE NO <br /> <br /> ....... SJ~SZ ~ENT,~ ~L. ~;.C~S~;~-~E~UJ'~ES ........................................... <br /> MAILIN~ ADDRESS; SUBDIVISION; <br /> <br /> ..... ~-~;~-SREE4(- GS~'RTB~ .................. <br /> 2416 S'f~TE ST <br /> <br /> ~ Hi)N,:, 375'-'9B52 VALUATION: <br /> ,~OT; BLOCK; SECT ON TOWNShiP'; ................R~E .............. Z~; ....... ; MAP: <br /> <br /> ................ ~ ................ ~ ..................... ~ <br /> <br />,,, I ................. ~2___,.~ ................... ~_&._ _L .... 48~.& ...... L .............. Ng .............. N& .... <br /> <br />TYPE: BUIL~IH~ PERMIT OR APPLICATION NO: <br /> <br /> ITEM <br />BIJ J~L. DING FEE <br />PLAN F~EVIEW <br />~¢UILi)'[Ng STATF. SURCHARGE <br /> <br />PAYEE: C~pitol Awrling / !,~ch;L-,ta~ Holies <br />REI:F:IV[-':~) BY: PM " <br /> <br /> 9~57296 <br />ARONITECT/ENGINEE~ NO. <br /> <br />PHONE: <br /> <br /> TOTAl,,. ASSESSED FEES <br /> PREVIOUS RECEIPTS <br />. THIS RECEIPT <br /> <br />QUANTITY <br /> <br />AMOUNT <br /> $~8.50 <br /> $25.83 <br /> $1.93 <br /> <br />$65.46 <br /> <br />$65.46 <br /> <br /> ....................... mt::::::::":::::==: ......................... TYPE: II,J CHECK ¢: 0 <br />* THIS IS HOT A PERHIT. THIS ~PPLZCATiOH HUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING NUST ~E O0~PLETE~. 'IT',ES THE EESPOHSI~[L[T¥ OF THE ~PPLICRNT TO AS~RE THAT <br /> L[. NECESSARY INFORMATION HAS BEEN,PEOVI~Eg. <br /> <br />HETC, HT: SETBACKS: FR 10 <br />TOTAL SQ F'T: <br />STORIES: RS'-~ ..... <br />PLAN. AC'rl£ <br />EI,IERGY FAIH: SP .... <br /> <br /> OFFICE COPY <br />FORM # MC 15-56 REV, 4/90 <br /> <br /> <br />