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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 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />} am a registered builder OR ( ) the authori;~ed reC, resematlve <br /> <br />'The work will be pedormed by a registered builder. <br />Other <br /> <br />AUP~SV"LI,.E O~ 977~25 '. AU~, ~ZLJ,.E ~ <br /> <br />MILL' ..... <br /> <br /> SITE ~U~EE: <br /> VAL,,LJATZON~ $3,,000,,00 <br /> <br />C(!N Tt:::AC"F O,I;: HO. <br /> C:j~:,:[to;l, A~a:Lng / San'[':iam Ho <br /> <br />BUILDINC, FEE <br />Pi.AN RIEVJ:EW <br />BIJII,9ING STATE SURI'.;HARGF_ <br /> <br />TOTAL ASSFSSEI) FEES <br />P,~EVtOUS RkCEIP [~ <br />THIS RECEIPT <br /> <br />f~ALA~ 2E, ,CUE <br /> <br />$2.'.i. (ii3 <br />$1., 93 <br /> <br />RR':L 8 <br /> <br /> ,%Cl::.i.V~:.l) ;,~Yi~ p~ ' TYi;>~,P.' ;IN Ci,,IF_'C'.~% ~,~ ~ <br /> <br />FDLLOWIN~ M~ST BE COMPLETE~;' IT iS,THE: RESPONglBILITY OF :THE APPLICANT ~O ASSURr_ THAT <br /> LL HECESSAaY IHFORMATIOH]H~S,,BEEH PROVIDED, <br /> <br /> ;~J[,~'.r,[,m;' ~'~' "~-*~ ......... :J)~C:'':!~'~' ...... ~'-" ~:f~[ FT: :~ <br /> <br />{';;l!'Y ,,ILIR]',SI)]%});ON: BY_ ..................... ~.~ATE ....................ENER(;¥ PAT <br /> <br />FORM # MC ~-~ R~V, 4/90 OF FICE COPY <br /> <br /> <br />