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R~:~ive. d by:____, <br /> <br />MARLO., 4 COUN 1 ~t BUILDING INSPECTION <br /> <br />COMMIINr'fY D£VELOPI'..~EN ~ C ENTER <br />285 Church S* NE · P. vom i 2 <br /> Salem. OR 97301 <br /> <br />ZA. CONTRACTOR INSTALLATION ONLY <br /> <br /> ?:: _/9.....8_0:_.'.± ......... <br /> <br />2B. FOR OWNlhR INST,Od~LATIOIq$ <br />Property Owner OJ!~as* pnn0 <br />Ivfliiling Add.ss I Phone <br /> <br />3. PLAN RBVIBW ~CTION <br /> <br />Marion County does not require a plan review. <br />We will pwvide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application, <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />~]001 <br /> <br /> (Complete and enter [oral in Al below) <br />NEW~U~TION ~ ~D~ION ~ ~OCATION <br /> <br />SASE ~EE <br /> <br />For ca, addni' 100 fl, (ut> to <br />maximum ors00 fl.) <br /> <br />~rmx~mum of 590 fi; <br /> <br />// <br /> <br />103 ft. or fracl/oa 0~ereof <br /> <br /> TOTAL AMOUNT DUE <br />Receipt No, <br /> <br />$15.00 <br /> <br />$30.[.vo __ <br />$15~00 -- <br /> <br />s:o.oo//0 <br />$10.00 <br />$10.oo __ <br /> <br />$25.00 ~_.~ <br />$L5,00 ,, <br /> <br />$30.00 -- <br />$15.00 .. <br /> <br />$4,50 <br />$1o,oo <br /> <br />NIC <br /> <br />$ <br /> <br /> <br />