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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 - 4:80 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />t am a reoistered builder OR { ) tee authorized representative <br /> <br /> VIELLER~ RIUSSELL ;9~100-10~ COMME CIAL <br /> <br /> 1B5 9TH ST __ ( CONTRACT CITY: i UG8: i OCCUPAN~ LOAD: <br /> AUHSVILL, E OR 77725 PUMSVZLLE ~NO I <br /> <br />MAILING ADDRESS: J SUBDIVISION'. <br /> <br />5058 CONNERCIAL ST SE <br />SALEH~ OR 97302 <br />PHONE: ~7e-7S02 <br /> <br /> SM]LT_E_S.ADDIIION .................... <br /> <br />~ VALUATION: S0.~0 <br /> <br />TYPE: RU~LDIHC PERHIT OR ~PPLICATIDN HO~ <br /> <br />Cq~TE¢CT~R, NO. 07705 <br /> JL b~a~ley I~c <br />5877 6af¢i~ Rd SE <br />SaleM~ ~7301-0000 <br />PNONE~ <br /> <br />ARCHITECT/EN~INEER~ NO. <br /> <br />PHONE: <br /> <br /> ITEM QUANTITY <br />~E~OLITION 1 <br />BUILDING STATE SURCHARGE <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />AMO~JNT <br /> <br /> $0.50 <br /> <br />$10.50 <br /> $8.00 <br />$I8.50 <br /> <br />BALANCE DUE <br /> <br />PAYEE: JL Stanley Inc <br />RECEIVED BY: pm ..................................... <br /> <br /> 61194 <br />TYPE: IN CHECK ~': 0 <br /> <br /> ~ THIS IS NOT A PERHIT. THIS APPLIC~TIOH HUSTGO, THROUGH A REVIE~ PI~3CE~3 ~&~ERE THE <br />FOLLOWING HUST ~E COMPLETED., IT I5 THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />LL HECESS~Y ~NFORNATIOH HAS '~EEN PROVIDED. <br /> <br /> A~(~ U~CMT.~I...:, SETBACKS: FR / <br /> ZONING: BY ........ :BATE ...... r TOT:ALSO FT: 8 LS""/ <br /> ~EPTIO: BY~ ....... ~Z~ .... DA~E~--~ ...... STOEIE~: 1 <br /> .......... -~ .......... PLAN. ACTION: <br /> CITY JURISDICTION: BY .... .... ~ ~ATE___g ..... ENERGY PATH: SP: ....... <br /> REMARkSu QEMO - AOTO REPAIR ,SHOP , , <br /> <br />OFFIC~ COPY <br /> <br /> <br />