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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 8:0,0 - <br /> 24HOU. COOE-A-P,ONE. 588-7804 <br /> <br />I am performing work on a property I own or occupy· <br /> <br />of a registered builder, ~ V ' / <br />The work will be performed by a registered builder. <br />Oth , ..... <br />I have read and agree o he emssaedon he everses~e~ DAT~' <br />this document· <br /> <br /> ~AUTEES1 ~ RU.~mEI._L <br />i SITUS ADDRESS; ' ~RESIDENTIAL <br /> <br />n ~I~RORA OR ~7~82 ~ARION COUNTY NO <br /> RESIDE ~[[~k <br /> <br /> ~T _. <br /> <br />i ........................... ~ ...................... ~ ........... .~.25 ~..]. ~4c ..........L. No ................... J. NO .............. <br /> <br />YYPE= BUILDING PERNIT OR APPLICATION NO: <br /> <br />CONTRACTOR,, NO. <br />TAUTFEST~ RUSSELL <br />~175 5TH ST <br />HUBBARD OR 97832 <br />PHONE: ~81-~874 <br /> <br /> ITEM <br />BUILDING FEE <br />PLAN REVIEW <br />BUILDING - INVESTIGATION/DOUBLE FEE <br />BUILDING STATE 8URCNARGE <br />ZONING SURCHARGE <br /> <br />PAYEE: TAUTFEST~ RUSSELL <br />RECEIVED BY: PM <br /> <br /> 785~177 <br />ARCHITECT/ENGINEER, NO. <br /> <br />PHONE: <br /> <br />.TOTAL ASSESSED FEES <br />~REVIOU~ RECEIPTS <br /> TH~S RECEIPT <br /> <br />'BALANCE DUE <br /> <br />QUANTITY <br /> <br />ANOUHT <br /> $104.50 <br /> $67.93 <br /> $104.50 <br /> $5.23 <br /> <br />$287.39 <br /> $0.00 <br /> <br />$0.00 <br /> <br />58673 <br /> <br />............... -==:=_=::==:__:__:=== ............. TYPE: CK CHECK ~. 2110 <br />* TR~S KS NOT A PERH[T. THIS.APPLICATION MUST GO THROUGH A REVIEM PROCESS WHERE THE <br />FOLLOW,HO HUST BE COHPLETED. IT JS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> LC NECESSARY INFORHATiON HAS BE:EH PROVIDED. <br /> <br />PLaN REVIEW= BY ~ .. DATET-.%~_~2~?).~.' : HEIGHT: <br /> ..... STORIES: <br /> · PLAN. ACTION: <br />CITY JURISDICTION: BY ......... DATE.._~ ..... ~ ENERGY PATH: <br />REMARKS: STOP WORK RES/ACC PARTIALLY COMPLETE~ <br /> <br />1120 <br /> <br />OFFICE COPY <br /> <br /> <br />