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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 a registered builder OR he au hot zed represen a ye <br />of a registered builder, <br />The work will be performed by a registered builder. <br />Other ....... <br /> <br />f ' TAX LGY <br /> CATEGORY: <br />I Sf~HTtA;"I liflHF% , ~',-'c.-r~. '-~'T',,^, <br />l~i~b~'Abb~'~S~S: ! ~ r* :: ,,~ ~, ~/~:,~' ,~, r-~ .... <br /> <br /> ;C~¢ ~:?L L h?/,UE' -' <br /> )~ .-- 7'3 '6~i~iW: 0~: 'oc6u~ ~o~o: <br /> <br /> T ' <br />' : H ]:LL., CREEK <br />~ SZTE NUMgER: ~4-~5~5 <br /> F:'H 0 NE :: VA L UA T I ON :; <br /> <br />..... Z:~ ', 24 : ~ S 2 ~ RH 51 <br />W~T.: US.TH; ['~'~k ~%; 'gdT: <br />~, ,,,, ~ ' 46. f~ q'~ <br /> <br />PiCd,!UFAf:TURE):) ~'TR/.IC'T'URE F'LACI!'ff]{NT/f;ONRECTI[:~N <br />YlANUf:ACT!.tRF_'3 SfftlICTURE STATE FEE <br />PiAN!IF, ACTURt~::O STRUCTURE STATE. SURCHARGE <br /> <br />QUANTITY AMgUNT <br /> $9. <br /> <br /> TOTAL ASSESSEJ) FL-TES ¢521ir,:i.~J <br /> PREVIOUS RECEZPTS $~),, ~8 <br /> J'HIS RECEZPT ~{i2:L:~ 1.8 <br /> <br /> BALANCE DUE $~,. [~ <br /> <br /> THIS ~ NOT ~ PERMIT. TH~S APPLICATISN MUST gO THROU6H A REVZE~ PROCESS WHERE THE <br />FgLI_O~ING ~;JST ~E CONPLETE~. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSU~E <br />THaT ~LL NECESSARY INFORH~TIOH HAS ~EEN PROVI~E~. <br /> <br />L.S-'j, 5 <br /> <br />F?R'"'I b <br />,cji: <br /> <br />~ORM e ~C ~e-~ REv. 4/eo OF FiC E COPY <br /> <br /> <br />