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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 <br />of a registered builder. <br />The work will be performed by a registered builder. <br />Other_ <br /> <br />I have read and agree to the terms stated on the reverse side of <br /> <br />SIGNATURE OF APPLICANT: <br /> <br />CONSTRUCTION TYPE: <br /> <br />i[~ESIDENf'ZAL <br /> OCCUPANCY: <br /> <br />DETROIT : NO i <br /> <br /> 41:[? oCNAI-;;R AV HE <br />~ ,,~1..[,~, OR 973¢5 SITE NUMBER: 94-83089 <br />! PHOHE: 393-58~6 ; VALUATION~ $4,8~,,f30 <br /> <br />TYPE: BUiLglNG PERHIT OR APPLICATION <br /> <br />LOHTI,<At.,7 OR,, tlU. <br />AL. LIftS,, ROSE M <br />4119 SCI-IAFF"f~ AV I',IE <br />SALEfl,~ OF( 97~05 <br />PHONE: 3779-5836 <br /> <br /> ].TEH <br />BtJ I LD.~:Iq F~ <br />PI,AN REVIEW <br />BUII,,DINI; STATE SU~;~CHARGE <br /> <br /> 9857856 <br /> <br />ARCH I '¥'EC T/I""'N G :r N ERR: NO. <br /> <br />PHONE: <br /> <br />TOTAL ASSESSE~ FEES <br />PREVIOUS RECEIPTS <br />THIS ~ECEIPT <br /> <br />QUAIqT'fTY <br /> <br />AMOUNT <br /> $44.50 <br /> $28.?3 <br /> $2.23 <br /> <br /> $75,.6& <br /> $0.00 <br /> $75.66 <br /> <br />BALANCE DUE $0., <br /> <br /> PA?~E: AL,.[,.tES. ROSE H S9570 <br /> RECEIVED BY: PM. TYPE: IN 'CHECK ~: <br />* THIS IS NOT A PERfllT- THIS APPLICATION HUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOW~N~ MOST ~E COHPLETED.. IT IS ~HE RESPONSIBILITY OF THE APPLICANT TO ASSUA~ THAT <br /> LL NECESSARY ~HFORHATION HAS ~EEN PROV~E~. ' <br /> <br /> (,llY JURI~ DICTION, BY .................. BATE ENER6T PATH= SP'"' <br /> <br /> ,~.MA~i(.~: SNOW ROOF/EXPIRED PERmiT ~49788 (9~-3:[~9) <br /> <br />OFF[CE COPY <br /> <br /> <br />