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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 225 <br />s)20 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 ~t registered builder OR the authorized representative <br />of a registered builder, <br /> <br />Other. <br />I have read and agree to the terms stated on the reverse side of <br /> <br /> ~)h FE: 'il/I.&/94 'f'TME~ 7: 4:L~ 9~:3 <br /> <br /> OWNER; ......... b ........ <br />..........................................................HI-.1)';'IA.LKI:,.L~ &] {,kgb, F", ~k~'il <br /> <br /> EITUS ADDRESS; i CONSTRUCTtON TYPE'· <br /> <br /> BREITENBUSH L, OWER CANP <br /> PO BOX 68B <br /> SHEL'FON WA 9'8584 ~ITE NUMBEE: 94-~4282 <br /> I HONI.,,, 2~6.-264--6226 VALUATION: $8~ 648,. 68 <br /> <br />TYPE= BUiLdING PERNIT OR APPLICATIDH HO: <br /> <br /> 59468 <br /> <br />ARCH.[] LCT/ENG.LIIEER,~ NO. <br /> <br />PPI ) '~E= <br /> <br />QUANTITY <br /> <br />TOTAL ASSESSEg FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />AHOUNT <br /> $74.5[4 <br /> $48,, 43 <br /> $5,, 75 <br /> $S,, 73 <br /> <br />BALANCE OI.HS S0.,08 <br /> <br /> I' 'I%ff <br />BU '.1: L D I' N~", F'M;; <br />F'L,AN REV.l' EW <br />][;~UII..DINC, STATE SUf~CHARGE <br />Zt3N:U*If; SURCHAR6E <br /> <br />CONSl'~UC'rlON CEASES FORA PERiO~'OF,~gO, BAY$~ OR IF CONSTRUCTION FAILS T8 MEET ALL <br />EOUIREMENTS OF STATE LAWS AND MARION COUNTY BUILDING ANO ZONING DR~iNARCES~ THIS PERMIT <br /> ALL BECOME NULL AND VDI~, , <br /> <br />,H .',L f PA?'H~, <br /> <br />l)l':)l,lA¢,..~ C,, gOOD ,EY,~ HARIOFt COUNTY ~LIZLD~NG O,=',:'.[CIAL / BY <br /> <br />FORM # MC ~ 6-86 REV, 4/90 OFFICE COPY <br /> <br /> <br />