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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: $88-5147 8:00 ~ 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />am 8 registered builder OR ( ) the authorized representative SIGNATURE OF APF~LIOANT <br />have read and aDree to the term8 stated on the reverse side of DATE: L~ ,%.~.~ <br /> <br /> J , <br />AUMSV)LLE OR 9732S NARION COUNTY NO <br /> <br /> ~ , ! SZTE H~BER= 9~37~2 <br />PHO~ 769-536 VALUATION: <br /> <br />TYPE# ~UILDZHG PERHZT OR APPLICATION NO: ~1~5~329 <br />C TOR N <br /> <br />PHONE: 769-5364 PHONE: <br /> <br /> ITEM <br />BUILDIN§ FEE <br />PLAN REVIEW <br />BUILDING STATE SURCHARC~ <br />ZONIN6 SURCHARGE <br /> <br />TOTAL ASSESSE~ FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br />BALANCE DUE <br /> <br />PAYEE: PIE'TROK. CLARENCE <br />RECEIVED DY: mB ................................... <br /> <br />QUANTITY AMOUNT <br /> $56.50 <br /> <br /> $2.8~ <br /> $2.8~ <br /> <br />$98.89 <br />$98.89 <br /> <br />$0.00 <br /> <br /> &0872 <br />TYPE: CK CHECK ~: 2148 <br /> <br /> THIS IS HOT A PERHZT. ll4IS APPLIiIqTION ItU~lrEO THROUGH A REVIEW PROCESS #HERE THE <br />FOLLOWIHG HUST BE CSHPLETE9 ~T ~S, THE, RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> <br />ZO4tN6. BY -_-~--- DATE-~ .. TOTAL gQ FT: <br /> <br /> PLAN.ACTION: <br />CITY JURISDICTION: BY ................. ~ATE,..ZL£Z£L&_ ENERGYPATH: <br />REMARKS: ADDING DINING <br /> <br />170 <br /> <br />SETBACKS: FR ._~ <br /> LST~~ <br /> <br /> RR~ <br /> <br />OFFICE COPY <br /> <br /> <br />