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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 a property I own er occupy. <br />I am a registered builder OR the authorized representative <br />of a registered builder, <br />The work will be performed by a registered builder. <br />Other .................... <br />I have read and agree to the terms stated on the reverse s~de of <br />this document. <br /> <br /> SITDS ADDRESS: ~ CONSTRUCTION TYPE: i OCCUPANCY'· <br /> <br /> AU~SVILLE' 0R 97325 (~UMfVIL. LE ~ NO <br />fUSE OF BUILDING: N0 0F 8~00MS: <br /> <br />~i~i~-~ .................................................................. ~ '~b~i~Z~ ................. <br />I ~ HJ, i,,[,. ,,k::.x ESTATES <br />~ ~ rITE NUM~ER= ~4-8~542 <br /> <br />TYPE= BUILgiNg PERMIT OR APPLICATION HO= <br /> <br />ARglt], l ~CT/Ei,u THLER,~ <br /> <br />PHONE: <br /> <br />TOTAL A~SESSEg FEES <br />PREVIOUS REOEIPTS <br />TH;(S RECEIPT <br /> <br />BAI.tANC[: DUE <br /> <br />C~UANT]:TY <br /> <br />A M, 0 Lt N T <br /> $25,. <br /> <br />$65,46 <br /> <br />$65., 46 <br /> <br /> RF',C~,iVE~ t~Y: I:m ..................... 4~,J .........................................TYPE: IN CHECK '~': 0 <br /> <br />* THIS IS NOT A PERMIT. T~IS APPLICATION H~ST gO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLONIHG MUST BE COMPLETED. I~ ~S THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> LL NECESSARY IHFORM~TtON HAS 9EEN PROVI~E~. <br /> <br />HEIGHT: SI~?¥'})AC;,~S,,; F:'F~ 22 <br />TOTAL SB F'T: 308 I,..S'6 <br />STORIES: ~RS' <br />PLAN. ACTION: R rd'" ]' C,'- <br />ENERGY ~::' ~ T ',"~ ~ SP, <br /> <br />~ORM # MC 15-56 REV. 4¢90 OFFICE COPY <br /> <br /> <br />