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MARION COUNTY BUILDING iNSPECTION <br />SENATOR BLDG, NO, 225 <br />220 HIGH STREET NE <br /> ~, SAt~M, OREGON 97301 <br /> PHONE 588-5147 <br /> CODE-A-PHONE 4:30 P.M. - 8:00 A,M. <br /> <br /> lamaregisteredbullderOR( )theauthorlzedrepresentative <br /> <br /> The work will be performed by 8 registered builder, <br /> Other__ <br /> <br /> DATE: 04/2?/8? TIME: 3: 12;52p <br />OWNER; <br /> BLALOCK, VERNON <br /> <br /> 9467 STAYTON RD <br />AUMSVI L L~ <br /> <br />USE OF BUILDING'. <br /> <br />SIGNATURE OF ARF'LICANT; <br /> <br /> TAX LOT:; CATEGORY; <br /> R <br /> CONSTRUCTION TYPE: ' OCCUPANCY; <br /> <br /> 0C AD: <br /> SE CoN~R,~'¢ CITY: : UGB'. , <br />OR 97325 <br /> <br />RESIDENTIAL ACCESSORY STRUCTURES , SUBDwi~iGh: <br /> <br /> S.a, ylE <br /> <br /> PHONE: 769-6187 <br /> <br />LOT: BLOCK; <br />WICTH: DEPTH; <br /> <br /> SITE NU~V~ER: 'l 194 <br /> : VALUATION: ~o '~ -, <br />i SECilON; i ToWN~NiP~ ' R,AN~ : ZO~'. MAP: <br /> <br /> 24 95 2N EFU <br /> q 4. OOCO AC H, N <br /> <br />'TYPE: BUILDING <br /> <br />CONTRACTOR, NO- <br />~LALOCK, VERNON <br />· ~, ,ME <br /> <br />¢>HON E ', 769~6187 <br /> <br /> i TEM <br />1gU ILOING FEE <br />PLAN REV I b"9~ <br />FLEET ,gJRCHARGE -ZONE 3 <br />STATE ~ RCHAF~;E <br />ZO~ LNG SURC~ IAF<GE <br /> <br />PAYEE: SLALOCK, VERNON <br />RECEIVED BY; J8 <br /> <br />m THIS IS NOT A PERHIT. THIS <br />FOLLOWING Iv~UST BE COHPLETED. <br />ALL NECESSARY INFORI~IATION <br /> <br />PERMIT OR APPLICATION NO: <br /> <br /> 9001823 <br /> <br />ARCH ITECT/P~GINEER, NO, <br /> <br />PHONE: <br /> <br />QUANT I TY A!v~OUN T <br /> $38,50 <br /> $25,03 <br /> $3.84 <br /> $ !. 5~ <br /> ':F ! 9 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$?0.84 <br /> $0,00 <br />$?0,84 <br /> <br />BALANCE DUE <br /> <br />$0,00 <br /> <br />INVOICE NO: 2308 <br />TYPE: OK CHEC,% ~: 1079 <br /> <br />A REVIEH PROCESS N'-IERE THE <br /> THE APPLICANT TO ASSURE THAT <br /> <br />AL.AN REVIEW: BY <br /> <br />SEPT IC; 8Y .............. DATE <br />ZONING: BY~_~___ CATE__ <br />REMARKS: <br />I".'E ~GHT: TOTAL ~ PT <br /> <br />ON: BY ........... DATE ................ <br /> <br />OFFICE COPY <br /> <br /> <br />