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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />:~IO 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 />lam performing work ona ropertylownoroooupy, <br />I am a ?egistered builder O~ the authorized representative $~GNATURE 0¢ APPLICANT: <br />Of a registered <br />The w~rk will be performed ~y a registered builder. <br /> <br /> , <br /> 3~.~ ~SPEN DR <br /> <br /> ~ I D~',N~ ].AL,, ACCESSORY <br /> <br /> ~ILL C~EEK ESTATES <br /> SALgH~ OR 973e2 SZTE NUH~E~ <br /> PHONE: ~71-~625 VALUATION: <br /> <br />CONTRACTORw NO, 963~ <br />JOHN ROEI.{M CONSTttU,C, TION <br />17277 S FERI'IWOOD <br />HOL. AI. LA~ , ?7038 <br />PHONE: 82~-487~ <br /> <br /> Il'EM <br />B[JZLJ)IN6 FEE <br />PLAN REVIE:W <br />BL)ILDINE STATE SURCHARGE <br /> <br />ARCHITECT/ENGINEER~ NO,, <br /> <br />PFIDNE: <br /> <br />QUANTITY <br /> <br /> TOTAL AS~EGSE9 FEES <br /> PRE'VIOUS RECEIPTS <br /> THIS RECEIPT <br />BAL~NCEDUE' <br /> <br />AMOUNT <br /> $44,56 <br /> <br /> $2..2~ <br /> <br />$75,, 66 <br /> <br />$7.~,.(6 <br /> <br /> F hYEI:.,, ,JONN ROEHN CaHSTRUC:T, ZON:: 6,.' ,.,7;): z, <br /> RLCLIVE~ BY: P~ :: TYPE:~ IN CHECK <br /> <br />· THiS IS NOT A P[RHIT.: THIS APPLICATION HUST GO THROUGH A REVIE~ PROCESS ~HERE THE <br />FOLLOWING flU~T ~E CO~PLETEb~ :IT IS THE RESPONSIBILITY OF THE APPL~CRHT TO ASSURE THaT <br /> LL HECESSARY [NFORHATI~N HAS ~EEN <br /> <br /> PLAN REVIEW: BY- <br /> <br /> ~EP'fI8= D~TE~ ........... 8TORZEB. 1 RS-'~ ....... <br /> ?. ~ .... . PLAN,ACTION: , ."- <br /> CIFY JUl. Z,~J)[gr~8~l. BY ........ .....~TE .......::..:gg.~g ENERGY PATH~ SP]'.; ......... <br /> REMANKSc CARPDRT : <br /> <br /> OFFICE COPY <br />FORM # MC 15.$6 REV, 4/90 <br /> <br /> <br />