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MARION COUNTY BUILDING INSPECTION <br />COMMUNWY DEVELOPMENT CENTER <br /> <br /> 285 Church Street NE · Room 132 · Salem, Oregon 97301-3670 <br />Office Hours: 8:00-4:30 · Phone: (603] 588-5147 · 24-HR Inspection Line: (503) 373-4427 <br /> <br />~ORK ~F~C : <br /> <br />EX[ST SEDROOM~= <br />FXTST EMP[OYEF: <br /> <br />~'[FE AOl)RESS : <br /> <br />SFTMINOR PARTITION PARCFL ] OF 4 <br /> <br /> PROPOSED BEOROOMS : 3 <br /> PROP[V3EDEMPtOYEES: <br /> <br />991] BROWNE[[ DR SF AM <br /> <br />CITY: MARION COUNTY <br /> <br />CROSS STRFFT : <br /> <br />PARCEt. NIJMBER : <br />PARCEl 5~7F : <br /> <br />SHAW HY SE <br /> <br />7529~-17g <br /> 5. B~ AC <br /> <br />LO'[: BLOCK: <br /> <br />r)WHER <br /> ADDRFSS <br /> <br /> PHONE <br /> <br />AMACK. MEI.V~N K & MARY <br />67~ NORWOOD DR <br />WEST F~FLO, N.J <br /> <br />AIITH AGFNT <br />PHONE <br /> <br />C[ARAMBEAU, CRAIG A <br />PO ROX ll <br />STAYTOH <br />OR <br />9]8-2300 <br /> <br />OEQ [HBTfiI.LER : <br /> <br />PHONF : <br /> <br />IJn~ts <br /> <br />97383-e011 <br /> <br /> DEQ LICENSE: <br /> <br />Oescr~ption Fee <br />S~te eva~uatfon' <br /> · r 226.25 <br />OEO Sur.harge 30.~0 <br /> <br /> Assessed fees : 256.25 <br /> Adjustments : .00 <br /> Tote] fees : 256.25 <br /> PAYEE: CLARAMBEAIJ,CRAIG A To~al pa%ments~ 256.25 <br /> Balance ~ue : .00 <br /> <br /> N-- _PE~[T..[~.IS THE ~[BIL[~ ~ ~ ~ TO~ T~T ~LL <br /> ff~ ~T~ I9 ~[~D. ~ ~ ~ ~ ~NTS ~ THE ~V~E~ <br /> <br /> S,~NAT,,RE ,F APP,.~CANT: ~ ~ ~~ _ <br /> <br /> DONALD E. WO[}OI.~Y~ HARTON COlJHTY BIJ~I.DIN~ OFFICIAL / DY H~ULL <br /> <br />............... F~ ~FICE USE ~LY. THIS IS ~T A PERHIT ........ HAP: 48R <br /> <br /> ~TIC ~IE~ DATE~ Z~N~ R~IEW~ DATE~ <br /> <br /> <br />