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MARION COUNTY BUIL[)ING INSPECTION <br />SENATOR BLDC--, NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-$147 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 688-?904 <br /> <br />l am ~ registered builder OR ( )theauthorizedrepfe~entative <br />Other. <br /> <br />DATE;~ 06124194 <br /> <br /> ~58 CLEVELhl4~ ST - .................................... <br /> j <br /> <br /> PO BOX 78~ i MERRIFIELI)S ADDITION <br /> : ~UMSVILI..E. OR 97~5 SITE N~MBE~: <br /> FHONE: 749-.~.178 ,, VALUATION:: <br /> <br />, ,. & '. 25 8S ~ 2W ~ RH ,51 <br /> <br /> TYPE: BUILDIHG PERHIT OR APPLICATION NO: <br /> OON'FRA~TORv NO. 25~g~ ARCHITECT/~N~IN~ER~ <br /> Nichols Co¥~struct:).on <br /> 12164 W St~yton Rd <br /> F HONE: 7~-"298~] : PHONE~ <br /> <br /> ITEM QUANTITY AMOUNT <br /> BUILDING FEI~ <br /> PLAH REVIEW SURCHAF~GE <br /> BL~:~iL, I)~NG STA'FE $4. %" <br /> <br /> TOTAL ASS~SSE9 FEEo $167.48 <br /> : PREVIOUS RECEIPTS <br /> ,: THIS RECEIPT ¢167. <br /> , B~LANCE DOE $8,. ¢}8 <br /> <br /> ~ THZS IS NOT A PERHIT. PROCESS WHERE THE <br /> FOLLOWIHG HUST BE THE APPLICANT TO ASSURE THAT <br /> LL HECESSARY INFORHATIOfl <br /> <br /> ZONIHC: BY : ::~E: ¢~ TOTAL S~ FT: J. 888 LS-'7 <br /> PLAN;ACTION: <br /> <br />OFFICE COPY <br /> <br /> <br />