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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: 5S@-7904 <br /> <br />I am performing work on a property I own or occupy, <br />I am a registered builder OR ) the authorized representative SIGNATURE OF APPLICANT'. <br />of e reDistered builder. <br />The work will be performed by a registered builder, <br />Other <br />I have read and agree to the terms stated on the reverse side of DATE; <br />this document. <br /> <br />TYPE: ~UZLDING PERHIT OR APPLICATION NO: 9a56~e7 <br /> <br />CONTRACTOR. 140. 56040 <br />Lenard R 01sm~ <br />S573 Crooked Finqer~Rd <br />$cotts Ni].ls~ 9737~-00~ <br />PHONE: 87~-2778 <br /> <br />BUILDING FEE <br />PLAN REVIEW <br />BUILDING STATE SURCHARGE <br />ZONING SURCNARGE <br /> <br />ARCHITECT/ENGINEER, <br /> <br />PHONE: <br /> <br /> QUANTITY <br /> <br />fOTAL ASSESSED FEES <br />PREVIOUS RECE.IPTS <br />THIS:RECEIPT <br /> <br />AMOUNT <br /> $74.50 <br /> $48.4~ <br /> $3.7~ <br /> $3.73 <br /> <br /> $0.00 <br />$130.39 <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE: Lenard R Olsen <br />RECEIVFD BY,~ PM ......................................... <br /> <br /> 58810 <br />TYPE: CK CHECK 4~: 2294 <br /> <br />~ THIS IS HOT A PERHIT. THIS'APPLICATIONNU~T,G0 THROUGH A REVIE~ PROCESS ~HERE THE <br />FOLLONING HUST SE COHPLETED."'IT:'IS,THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> LL NECESSARY INFORHAT[ON HRS BEEN PROVIDED. <br /> <br />SEFTIC: BY ......... ' ............DATE::__:':_:::::: <br />CitY JURISDICTION: BY ........... DATE ............ <br /> <br />REMARKS: ADD','. ENTRY & OFFICE TO MS <br /> <br />HEIGHT: SETBACKS: FR <br />TOTALSQ FT: 240 LS"~'"~ <br />STORIES: 1 <br />PC. AN. ACTION: RR'-~g, .... <br />ENERGY PATH: 1 SP' ............. <br /> <br />OFFICE COPY <br /> <br /> <br />