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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 ~~.- v (~ ~ t~ <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />t am performing work on a property I own or occupy. ~,×~'~ / <br />I ~m a registered bullder OR ( } the authorized representative SIGNATURE OF APPLICANT: <br />of s registered builder, <br />The work will be performed by a registered builder. <br />Other_ <br />I have read and agree to the terms stated on ~he reverse side of DATE~ <br />this document, <br /> <br />~-~S '~D~ ; CONSTRUOTION TYPE'. ~ OCCUPANCY: <br /> <br />f 11842 D~LY RD NE ~ 60NTRAGT 61TY'. ', UGS'. ~OOOUPANT kOAD: <br />I ~UROR~ OR ~70~2 ~RION COUNTY <br /> <br /> 13442 CRATER LAKE CT <br /> PHONE: &78-2~71 ~ VALUATION: $72,847. e8 <br /> <br />Iw~ DTM ~ 7~-~ OSPTH ~¢ ~ $~AZ F~UN TS t llE~EG, LOT: ~ CORNER; <br /> <br />TYPE: DWELLII~ PERMIT OR"APPLIE~TION NO= <br /> <br />C011TRACTOR. NO. <br />GOPF. GREGORY <br />15442 CRATER LAKE CT <br />AURORA, OR 97802 <br />PHONE: ~78-2371 <br /> <br /> ITEM <br />DWELLINE BUILDING FEE <br />DWELLING PLUMBING <br />DWELLING MECHANICAL <br />DWEt. LING ELECTRICAL <br />DWELLING STATE SURCHARGE <br />~WELLIN6 PLAN REVIEW <br />ORNPIKE D/W - BLDG INSPECTION <br />TURNPIKE B/W - PUBLIC WORKS <br />DWELLING ZONING SURCNARGE <br /> <br />ARCHITECT/ENGINEER~ NOw <br /> <br />PHONE~ <br /> <br />QUANTITY <br /> <br />AMOUNT <br /> $3~3.,79 <br /> $132.85 <br /> <br /> $31.65 <br /> $185.00 <br /> $2.00 <br /> $48.00 <br /> $15.00 <br /> <br />TOTAL ASSESSED FEES $914.73 <br />PREVIOUS RECEIPTS $0.00 <br />THIS RECEIPT $914.7~ <br /> <br />BALANCE DUE $0.00 <br /> <br /> E 0 EGORY TYPE: CK CHECK ~: 1472 <br />* THIS IS NOT R PERHIT. THIS APPLICATION HUST r~ THROUGH A REVIEW PROCESS ~HERE THE <br />FOLLO~IH; HUST BE COHPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> LL NECESSARY INFORHATiOR,HAS BEEN PROVIDED. <br /> <br />SEPTIC: BY <br /> <br />CiTY JURISDICTION: BY ])ATE <br />REMARKS. DP: STD <br /> <br /> OFFICE COPY <br /> <br />~EIGHT: 25 SET~ACKS: <br />TOTAL SQ:FT~ 2261 LS~ <br />STORIES: 2 <br />PLAN. ACT:ION: <br />ENERGY PATN: SP <br /> <br /> <br />