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MARl'ON 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 a registered builder OR ) the authorized representatNe <br />ota registered builder. <br />The work will be performed by a registered builder, <br />Other <br /> <br />SIGNATURE OF APPLICANT: <br /> <br /> DATE: <br /> <br />TYPE: BIJILBING PER~IT OR APPLICATION NO: <br /> <br /> :ITt<il <br />BI, I;U,,D I NJ, FEi(. <br />F'LAN REVIEW <br />,~,UZLD:(I'~(; STA'TF ,StJRC, H,A~'~E <br /> <br />AF~CH I TECT/Et~t(; I WF, ER~ <br /> <br />r, H 01~, E ii <br /> <br />QUANTITY <br /> <br />AHOUNT <br /> <br /> $ ! ,, 95 <br /> <br />"i-DTAI, ASSE~ SED FEES $65,46 <br />PREVIOtJS RECEIPTS .......... ,~.¢/.}, ~,,,., <br />Tf"L'I:.S REOEIPT '~65,, I/~ <br /> <br />BALANCE DUE '~i ~ <br /> <br /> 6~)544 <br />TYPE: tN (]:-,t:.'t'~ ,~x: ~) <br /> <br />LL NECESSARY INFORMATION ,NAS BEEN PROVIDED. <br /> <br /> r :::::::::::::::::::::::: ':]:]:::':':':-'::Z <br /> , ~Y ,JU~.o~[ ,.<_,N~ ~Y ..................... ~T~ ................... <br /> k flFk~. (AM- I <br /> <br />HEIGHT: <br />TflTAL SCi F'T~ S8~ L~" <br />STORIES: ': <br />PI. AN.ACTION: RR <br />ENERG~ F'AT~'~: S F'"' <br /> <br />FORM # MC 15-56 REV. 4/90 OFFICE COPY <br /> <br /> <br />