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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 performing work On 8 property I own or occupy, <br /> I 8m a registered builder OR ( ) the authorized representative SIGNATURE Or APPL CANT: <br /> <br /> The work will ~e pedormed by a registered builder. <br /> O~her <br /> <br /> DALE.. 12/12/~4 TI~E: 10.45.42 <br />' 0~ ";;; f~X'[5~: ~, , ',,,, <br /> <br />, ¢~TUS ~Db~ESs. 85~T~UCTid~ f~['. <br />', <br /> <br />,us~ OF eu ~%~iFACTUR~ <br /> <br /> ~ fl~LL CREEK EST~TE~ <br /> 28ll LYNA NE <br /> .,AL. EH,~:" OR <br /> PNOplE= 375-6296 <br /> <br />TYPE: BUILD/N[; PERHiT OR RPPLICAT;[DH <br />COI,]TRACTOR,~ NO. :1. 4~222 <br /> COHH Woorlbur ~ <br />285 S Pac:i, fic <br />Woodburn. ~7071--¢000 <br />PNONE... 981..-,~ 14 ! <br /> <br /> ITEM <br />BUILD[fIG FEE <br />PLAH REVIEW <br />~UII..DING STATE SURCHARGE <br /> <br /> ?~8188 <br />ARCHITECT/ENGINEER, NO. <br /> <br />PHONE: <br /> <br />~UAN'I'ITY <br /> <br />I'OTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />AHOIJ}'4'I' <br /> $44.50 <br /> <br /> $2.23 <br /> <br />$7:5,, 66 <br /> se. 00 <br />$7 . 46 <br /> <br />BALAN(;E DWE ~,, 08 <br /> <br /> PAYEE: CCHH Woodburn IYtc 62'791 <br /> RECEIVED BY: PM ............................................... TYPE: IN CHECK ~: 0 <br /> <br />~ THIS IS MOT A PERHIT. THIS APPL[CATIO~ MUST G~ THROUGH A REVIE~ PROCEBS WHERE THE <br />FOLLOgIHG MUST BE 6OMPLETEB. IT IS THE RESPI~iNSIBILITY OF THE APPL%OANT TO ASSURE THAT <br /> LL NECESSARY INFORMATION H~S BEEN PROVI~E~. <br /> <br /> BY__..,__._,.___,,,~ DATE ............ <br />OEF'TIC:: BY ......................... DATE-,T--'- <br /> <br />C:r.';'Y JUI;:I,SDICTION: BY ............ DATE <br />¢(E.l"tP, EKo,, CARPOR f <br /> <br />HEIGHT: SETBACKS: FR 'l( <br />TOTAL ~Q FT: 388 LS .... <br />~TORIE$: kS ~ <br />PLAN. ACTION: RR":t~ <br />ENERGY PATH: SI::'I ........... <br /> <br /> <br />