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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 />Other,, <br /> <br />this documer~t. <br /> <br />SIGNATUR~ 0¢ APPLICANT: <br /> <br /> d,~W~;~)A) t 08/0?/?4 ...... T~,.,~:,--.~:.JT.~4~ .......... ~AX'LO~: ........... CATEGORY <br /> 6RON[-~YE.R~ <br /> ~ ~ RES:[DENT:[AL <br />~8 US ADORESS; CONSTRUCTION TYPE; ~OOUPANCY'. <br /> <br />, AUHSV:~LLE 0R 97525 ~AOHSVZLLE ;NO <br /> <br />' RI,,,~ZDE 4 f ~[.. ~CCE, SSORY STRUCTURES <br /> <br /> ~ E- ' ST ' "~ <br /> &I~73 ~',rl..L CREEK RD SE =_JI.~L_C.BI EK,,E~,~ ,~[E> .......................... <br /> <br /> r"flONIE: L~YR-,~968 VAL[JATION: $3~,,88 <br />fC~f: .................... fl'g~ ............... E~ fF6 ~: ................ -~RTE ............. ~X~E~ ........... ~SW-[T ......... ; MAP: ' <br /> <br /> TYPE: BU~L~ZN6 PER~IT OR APPL~C~TIO~ NO: 9~57188 <br /> <br /> CgNTR(~CTOR~ NO. 98~40 AF(CHI'f'ECT/EN~ZNEER,, NO.. <br /> 518 Val].eywoo:l l)r <br /> ~aien~ 773~6 <br /> PHONE; 363...1711 PHONE: <br /> <br /> J:I'EH QUANTITY ~OUNT <br /> [{(J lf,,,~ INE FEE <br /> PLAH REV]:EB $2~,, <br /> BU;[J,I)IHG SThTE SURCHARGE $1.93 <br /> <br /> TOTAL ARSESRE~ FEES <br /> PREVIOUS RECEIPTS $8. ~0 <br /> TH..S RECEIPT $~5., 46 <br /> <br /> B~I.;ANCE ,DWE <br /> <br /> ?YEE: CapJ, toI Aw~:Lng 59698 <br /> RECEIVIZ~) BY: PM TYPE: IN CHECK ~: <br /> <br /> * THIS IS NOT A PERHIT. THIS A~PLICATION HUST ~ THROUCH A REVIEW PROCESS WHERE THE <br /> FOLLO~IN~ ~UST ~E CO~PL~E9. ~T IS THE ~ESPONSI~ILITY OF THE APPLICAHT TO ASSURE THaT <br /> LL NECESSARY INFORMATION HAS BEEN PRO~I~E~. <br /> <br />ZOH:I. Nf;:PLAN REVIEW."~y [IY,..~ ....... bATEi)A.f,E .................... ~'[~ '''¢t'fl <br />SEPTIC: I;,~Y ............................ OATE ................... <br /> <br />CI:'FY JURI, Dig f':[ON. '~Y ................ ,SATE ................ <br />J'::EHARK!~: CAF<PORT <br /> <br />14EIGHT: SE"I'BACK,~-?;; FR 10 <br />TOTAL ,SQ '-"f: 300 LS .... <br />'STORIES: 1 F,,,,~'~. ''''~¢, ...... <br />PLAN. ACTION: F:R'"' 10 <br />-"NEI:~GY PATH: SF'- <br /> <br /> OffiCE COPY <br />~ORM # MO 15-58 REV. 4/90 <br /> <br /> <br />