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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NC). 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 8m 8 registered guilde¢ OR ( ) the authorized representative <br />of a registered builder, <br /> <br />/ ~W,k~)AI:E r. t~/l-.t/94 I:;I.NE~- Z. 2-:.&~-:-2& ................. '~ R <br /> KEIZER BOILDING & ~ESlgN <br /> I <br /> T <br /> I <br /> A <br /> L <br /> ~i~ X~7 ~STRUOTION TYPE: ! OCCUPANCY: <br /> <br /> / 8ITE NU~ER. 94-83972 <br /> PHONE: ~ VALUATION: <br /> <br />f~7'; T'¢L'dCE; ............~¢~ .............. T~8~q~5 ~%~E; .... T'~6~'~i ~*~.. <br /> <br />[wFb~H: IO~PTH; ~ AREA: lu NITS: I · : ~ : <br /> ............. ........ ....... ........... uo_ .............. .................... <br /> <br />TYPE: D~ELLIHG <br /> <br />CONTRACTOR~ NO. 63578 <br />~ike Kubishta <br />4:t0 AppleblossoM Ave N <br />SaleM: 97~3-0B~8 <br />PHONE: <br /> <br /> ~TEM <br />DWELLING BUILDING FEE <br />DWELLING PLUMBING <br />DWELl. lNG MECHANICAL <br />DWELl. lNG ELECTRICAL <br />DWELLING 9TATE ~URCNARGE:! <br />DWELL, lNG PLAN REVIEW <br /> <br />PERHIT OR APPLiCATiON HO~ <br /> <br />ARCHITECT/ENGINEER, NO. <br /> <br />QUANTITY <br /> <br /> PAYEE: flJ, ke Kub~shta <br /> RECEIVED BY: js ..... ~ .: <br /> <br />* THIS IS HOT <br />FOLLOWIHG HUST ~E <br />LL HECESSARY <br /> <br /> FLAN REVIEW: BY _~&~,_ <br /> ZONING: BY <br /> SEPTIC: BY 1 <br /> ..................... ~--'r~ ...... PLAN. ACTION~ <br /> C~TY JURISDICTION: BY DATE <br /> REMARKS: NEW DWELLING:~R~E- <br /> <br />ANOUNT <br /> $286.40 <br /> $104.4~ <br /> $26.02 <br /> $81.55 <br /> <br /> $185.08 <br /> <br />$708.J2 <br /> $0.00 <br />$708.32 <br /> <br />TYPE: IN <br /> <br /> $0.80 <br /> 61397 <br />CHECK 9:' 0 <br /> <br />REVIEW PROCESS WHERE THE <br /> APPLICANT TO ASSURE THAT <br /> <br /> SETBACKS: FR 20 <br />1788 L.9"5 <br /> RS'"'5 <br /> RR"5 <br /> SF'= ..... <br /> <br /> OFFICE COPY <br />FORM # MC 1 :-~6 R~, 4/80 <br /> <br /> <br />