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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 />The work will be performed by ~ registeres builder, <br />Other <br /> <br />I have read and agree to the terms stated on the reverse side of <br />th~s document, <br /> <br />418 ~PP[,.EBLOSSON N <br />KE]:ZER, 0R ¢7~8~ I SZTE NU~ER= 95-~516 <br /> <br />TYPE.' I)~IELL ]'NG <br /> <br />CONTRACTOR.~ N0. <br />Mike Kubishta <br />~10 Applr~b,t,t:)SSmE~ Ave N <br />Sa le~% 97L~0,'~-0000 , :: ':;:: <br />PHONE: ~9~-6716 PHONE: <br /> <br /> PERN'rT OR APPLICATION Hi3= ~&11~ 9P <br /> <br />6So7E ARCFIITECT/EN¢tNEER~ N0. <br /> <br /> ITEM <br />DWELL. lNG BUII,.DII'II; FEE <br />DWELL. IN6 PLUNBIN6 <br />,gWELLING HECHANI6AL <br />1)WELI,.ING ELECTRICAL <br />DWELLINi; ~TATE <br />DWELLIN6 PLAN REVIEW <br /> <br />PAYEE: Mike Kubish't:e, <br />RECEIVED BY: <br /> <br />TYPE: <br /> <br />QUAIffI'fY AMOUNT <br /> $299.59 <br /> $t09.24 <br /> $2?,,22 <br /> $85,,S1 <br /> $26..07 <br /> $105,,00 <br /> <br />$732,45 <br /> <br /> $0.09 <br />6,3 7,~,, <br /> <br /> , TH'rS 't'$ NOT A <br />FOLLD~IN6 NtiST BE <br /> <br /> ZONIH6= ~Y ~ ~ ~ .... TBZ~L SB FT~ <br /> SEPTIC: BY E S~ORIES: <br /> ENERKY P~TH: 8 <br /> C:[TY ,~tJR [:~i~) ZCT'.~gN: <br /> REMARKS: NEO REO <br /> <br /> REVIE~ PROCESS WHERE THE <br />:THE APPLICANT TO ASSURE THAT <br /> <br /> OE'rBACKS;; F'R ,~.(.. <br />1062 ° ' <br /> <br /> !:;. ~::: "" 5 <br /> <br />OFFICE COPY <br /> <br /> <br />