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MARION COUNTY BUILDING INSPECTION <br />SENATOR m~LDG, NO, 225 <br />220 HIGH ST,~EET NE <br /> SALEM1 OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> , am performing work on a property, own or occuoy. .~. ~ ~ ~...~.~ <br /> I em ~ registered builder OR the authorized representative SIGNATURE OF APPLICANT' '~ <br /> of a registered builder. <br /> The work will be performed by a registered builder, <br /> Other <br /> <br />this document. <br />DATE= 12/02/94 T~E~ <br />'°WN~ACEmTE,~ RALPH / TAX LOT, ~TIAL <br /> <br /> 11418 FARGO RB HE ; <br /> <br />............................................................................................................................................... <br />~us~ o~ ~um~6TURES OTHER THAN BUIL~IN6S <br /> <br /> ~8~ ........... [~Eb8k; ............. ~'~8~'idMi ......... ~ ~'~%~ ........... ~X~ ~-~d~ <br /> , ~ , 48 tW , EFU 4 <br /> <br />iWlDTH: I [DEPTH: , AREA i UN ~s m ~eg LOTr <br /> <br />TYPE= 8UILglN§ <br /> <br />Co~'rRACTOR~ NO~ <br />RACET'FE~ RALPH <br /> <br />PERMIT OR APPLICATIOH NO= ~&0~13 <br /> <br /> ARCHI'FECT/ENGIHEER, NO. <br /> <br /> PHONE= 678-1~68 PHONE= <br /> <br /> ITEM OOANTITY ANOUNT <br /> ADDITIONAL BUILDINI; FEES $10,00 <br /> <br /> TOTAL ASSESSE9 FEES <br /> PRE~:IOUS RECEIPTS <br /> .THIS ~ECEIPT $1e. <br /> <br /> : BALANCE ~UE <br /> PAYEE: ~ACETTE~ RALPH <br /> RECEI~b'Q BY~ ~F TYPE: 6K CHECK 8: 2786 <br /> · THIS ~$ NOT A PE~HZT. HUS~ ~ :THROUGH A REVIEW PROCESS WHERE T E <br />FOLLO~IH~ HOST BE COHPLETED. ZT[S THE RESPQ~:~B[LITY OF: THE APPLICAHT TO ASSURE T~AT <br />LL NECESSARY IHFORHAT~OH HAS BEEH PROVIDED. .... <br /> <br /> Z0qlI4G. B ~ DATE TOTAL S~ <br /> SEPTIC: BY ........................ ~ATE~%: <br /> SETBACKS. <br /> <br /> 1 <br /> PLAN,, ACTION: <br />CITY ,JURISDICTION: BY ~ I)ATE. ENERGY PATF: <br />Fd:.HARI(S. I)EM0 <br /> <br /> g&,,,.- : U <br /> <br />C: riCe COPY <br /> <br /> <br />