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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 ) the authorized representative <br /> <br />The work will be performed by a registered builder, <br />Other <br /> <br />I have read and agree to the terms stated on the reverse ~ide of <br /> <br /> AUH,:W ILL, E OR 97325 <br /> S I N,6LE E~ H i L,%, LLZ.b[ES. ................................................................. <br /> <br /> 41~ APPLEBI_OSSOH AV N <br /> SAI,,,EM~ 0R ?'7~ SITE NUMBER: <br /> PHOH[: S9~'-6716 VALUATION: <br /> <br />CON'fRACTOE, NO. 63578 ARCHITECT/ENG]i:NEER, NO,. <br />M~ke Kub:i, shta <br /> Appleblossom <br /> Aw <br /> N <br /> ,,,', <br />PHONE: 29(a-6716 ,f <br /> <br /> I TEH <br />DWEL, LIN~ BUILDING F'EF i <br />DWELLINC PLUMBIHG ::' <br />9WEI,,L. IIq(; HECHANIC~L <br />DWELLING EL. EC'TRIC~L <br />DWELI,,IN~ ~'rAl'E <br />DWEI,,,t,,II,IG PLAN REVIEW ','. <br /> <br /> QUANTITY AMOUI,tT <br /> $25%42 <br /> "~92,, 41 <br /> $~3.0~ <br /> $7~. 16 <br /> $2;2 ,, 05 <br /> $185.00 <br /> <br /> $648.06 <br /> $648.06 <br /> <br /> $0,00 <br /> 63721 <br /> TYF:'E: IN CHECK ~: <br />'A REVIEW PROCESS WHERE THE <br />THE APPLICANT TO ~SURE THAT <br /> <br /> SETBACKS: FR 2~ <br /> 1575 <br /> <br /> sP] ........ <br /> <br /> PAYEE: Hike Kui)ishta ' <br /> RECEIVED ~Y: PM <br /> * T~I$ IS NOT A PERMI~. <br />FOLLOWING MUST BE <br /> LL NECESSARY INFORMATION <br /> PI.AN REVIE~ BY ~)~"'~'-"~'~ <br /> ZONING: BY ':,~ <br /> SKF"f ~C~ BY .............................. <br /> <br />TOTAl_ oO Fl. <br />STORIES: I <br /> <br /> ..................................................................... PLAN. ACTION: <br /> ENERGY PATH: 8 <br />CII'Y ,I JR[oD[[,FION: I,~Y DATE , <br />REHARKS: NEW RES .... <br /> <br /> OFFICE COPY <br />FORM # MC t §.56 REV. 4l~0 <br /> <br /> <br />