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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 /> I am a regJstePed builder OR the ~uthorized repreBentetJve <br /> of a registered builder, <br /> The work will be performed by a registered builder, <br /> Other <br /> <br /> this document, <br /> ]DA'fF',: ,1.1/07/94 I'iME,~ 10:12:28 <br /> <br /> KEtZ,~.R BL IL. DING & DE,~,[G'I ! i F~EolDENT:I. AL. <br />~ITUe ADDREee; I CONSTRUCTION TYPE: <br /> <br />MAILING ADDRESS; I SUBDIVISION: <br /> <br /> / SITE HUHBER: 94-8~972 <br /> PHONE: · / VALUATION: <br /> <br /> TYPE: DWELLING PERHZT OR APPLICAT[ON HO: ~88]e DP <br /> <br /> CON-[RACTOR~ NO. 63578 ARCHII'EOT/EIqG~NEER~ NO. <br /> Mike Kub~shta <br /> 418 Appleblossm~ Ave N <br /> <br /> PHOI,IE: ~eB-6716 / :,;, ;:: · =:: · :::-~ :--;: ::=~ :-.::= :.., :-:; ;::.~ ~HQI~E~: : <br /> ITEM ~UANTZTY <br /> <br />DWELLING BUILDING FEE <br />DWELLING PLUHBII,IG :: <br />DWELLING MECHANICAL ': <br />]DNELLING ,F:L,EC T,~;[I CAL. <br />I)WELLING STATE <br />BNIELLING PLAN RE¥IEW <br /> <br /> AMOIJNT <br /> $286.48 <br /> <br /> $8 t, 55 <br /> <br />: <br />=EEB $788., 32 <br /> $788~ 32 <br /> <br /> ITS ISSUE DATE. IF <br />FALLS TO HEET ALL <br />::ZONING OEDINANCES~ THIS PERH~T <br /> SETBACKS: FR 28 <br /> <br />PAYEE:~ <br />RECEIVED by: DF <br /> <br /> * THIS IS A VALI~ <br />CONSTRUCTION CEASES <br />EGUIREHEHTS OF STATE <br />ALL BECOHE HULL AND <br /> <br />FORM # ~ ~s-~.~, 4/~o OFFICE COPY <br /> <br /> <br />