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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 />COI~'FRACTOR. NO., 8818S <br />DARELL D. HUBERT <br />PO BOX 1881 <br />AUHS¥ILLE~ ~7~25-0800 <br />PHONE: 749-2023 <br /> <br /> ITEM <br />BUILDING FEE <br />PI_AN REVIEW <br />BUILDING STATE SORCHARGE <br /> <br />PAYEE: DARELL D,, HUBERT <br /> <br />ARCHITECT/ENGINEER~ <br /> <br />PHONE: <br /> <br />TOTAL ASSESSED FEED <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY <br /> <br />AMOUNT <br /> $104.50 <br /> <br />$],77.~8 <br /> $0,00 <br /> <br />~ALAHCE DUE $0.00 <br /> <br />62545 <br /> <br /> RECEIVED BY: PM TYPE: IN CHECK ,~: 0 <br />A THiS IS NOT A PERNIT. THIS APPLICATION NUST'GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST BE COMPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> LL NECESSARY INFORHATION HASDEEN PROVIDED. <br /> <br />PLAN REVIEW:~ DATE <br />ZSNING: BY .............. DATE-- <br /> <br />CITY JURI~;DICTION: DY ........... DATE <br />RI,SHARKS: ADD: BR <br /> <br />NEIGNT: SETBACKS: FR 20 <br />TOTAL SQ FT: 392 L_S-5 <br />STORIES: i RS-"5 <br />PLAN. ACTION: RR""5 <br />ENERGY PATH: SP]'j ....... <br /> <br /> CFFICE COPY <br />FORM # MC 15.68 REV. <br /> <br /> <br />