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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 />~ am pedormln~ wod~ o~ a proCe~t¥ I own or <br /> <br />The work will be performed by a regi*tered builder. <br />Other <br /> <br />TYPE= ~UIL~IN~ PER~ZT OR APPLICRT~OE NO: <br /> <br />COi, FrRAc'roR,, <br /> Dales <br />'l, 5,t~ E San'8:i,a~q <br /> <br />PLAN REVIE~ <br />i~U,i]L. BZI,iG BTATE SURCHARGE <br />ZPNII,Ig SURCHARGE <br /> <br /> 7057517 <br /> <br />ARCHI TECT/ENf; I NEEI:~ ~ <br /> <br />PHONE: <br /> <br />BUANTtTY <br /> <br />TOTAL A~SESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />BALANCE DUE <br /> <br />AHO~JhIT <br /> ~;92,, <br /> <br /> $4.63 <br /> $4.63 <br /> <br /> 6:[. l~19 <br /> ¢,0. Be <br /> 87 <br />$:L61 ,,. - <br /> <br /> F'AY~it,Z: l)ales Remodeling [nc 62896 <br /> F,E, Ci'.,I,V[:~ BYe' js .................................................... TYPE: CK CHELN ~ 7527 <br /> <br />FDLLOWIH~ NUST BE COHPLETED, 'IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> <br />.................................................................. PI AN,, ACTION= <br /> <br />250 <br /> <br />~OnM # ~c ~-s~ nec, 4t~ OFFICE COPY <br /> <br /> <br />