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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 /> {om performing work cna propert~r occupy. -_~~~~
<br /> 'o~ &r¢¢tiCtr:r~.~l~il~twill be OR the authorized reorese~ta,ive SIGNATURE OF ~A~
<br />
<br /> T~e~ark performed by a register~dZuild~r_
<br /> have read and agree to the terms Stated on ~he reverse side of DATE:
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<br /> ~ CONTRACT CITY: ~ UGB: OCCUPANT LOAD
<br /> ' '
<br /> ~ 5-N
<br /> BREtTE'NBUSH HOt'SPR:[NSS --
<br />6k ~UICGi~~ EOIT'~ .............................~(" -"~7~4~- .............. K~R'TON"~'~O0 NT ~
<br />
<br /> BRET, TENBUSH LOWER CAHP
<br />
<br />SHELTGN MA 98584 SITE NUMBER: 94-~4282
<br />F'.H ~ ~ 6-i,':¢~.4,-,52,-~ , T~QN, ,~4,~, ~
<br />
<br /> z ~ i Z .................
<br />
<br />TYPE~ ~U~L~ING PERMIT OR APPLICATION
<br />
<br />CONI'RACI'OF~,~ biO.
<br />HEII)Gt~RKI!~I,!, GEOkL E. f':'.
<br />PO BOX 688
<br />SI~I'_<LTON IfA 98584
<br />PHONE:
<br />
<br />[;d..llt PZIql; FlEE
<br />
<br />BUII..D].I'~(; S'IATE SIJR(]HAEEF:
<br />ZONJ[N[; SURCHAI',~GE
<br />
<br />Aik'CHI'f'ECT/ENG ]:HEER,¢ NO,,
<br />
<br />PHONE:
<br />
<br />T(;TAL ASEtI-~$SE:D FEES
<br />PREVIOUS RECEiF'TS
<br />'FHZS RECE:[F T
<br />
<br />QUANTI'FY
<br />
<br />AMOUNT
<br /> S260,,50
<br />
<br /> $13,,B3
<br />
<br /> I"(-,~EE. I. If,;ID.Ji, RlxEIlSf{.;l~OJ,):~7. I:". 6~.:t. 46
<br /> ':'%, ;: .... ~ ,, : · . ~:,, ', , :,',"'
<br /> ................ .......... ............
<br />·TH[S IS NOT A PERMIT. THIS APPLICATION MUST GO THROUGH A REVZE~ PROCESS WHERE THE
<br />FOLLOWIHG HUST BE COHPLETE~. IT IS THE RESPONSIBILITY OF THE ~PPLICANT TO A~URE THAT
<br /> LL NECESSARY INFORMATION HAS ~EEN PROVI~E~.
<br />
<br /> Pi,AN i ~;.V.[I--,~;:~' ' - BY ~A'fE HEI(;HT: 15 SE'f'~ACKS,: ""'",..,.,
<br /> Zr)H,(N~,; ~Y ....................... b~r:. TOTAL S~ FT: 432 ~': ........
<br /> SEF']I[;: BY ...................................... DATE ........................ STORIES: i R5 '
<br /> .......................................... ' .......................... PLAN. ACTIDN: ' '
<br /> r')TY ,RIR:[L;PlCTION: BY..,../,.,. ......... ,I)ATE ....................... ENERGY PATH: S':"...""~.
<br />
<br /> ~..'¢...~AI.,~K~';'~ CAB:Hq '1,1 "'
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<br />FORM # MC 15-56 REV, 4/90 OFFICE COPY
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