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MARION COUNTY BUILDING INSPECTION
<br /> BENATOR BLDG, NO, 225
<br /> 220 HIGH STREET NE
<br /> SALEM, OREGON 97301
<br />
<br /> PHONE ,588-5147
<br /> CODE-A-PHONE 4:30 P,M, - 8:00 A,M,
<br />
<br />I am a registered builder OR ( ) the authorized representative SIGNATURE OF ARRgJCAN
<br />of a registered builder,
<br />The work will be performed by a registered builder.
<br />Other.
<br />I have read and agree to the terms sta~ed on the reverse side of gATE;
<br />this document.
<br />
<br />DATE: 08/26/8? TIME: 10:50:01a
<br />OWNER:
<br />
<br /> BENJAMIN, PATRICK L.
<br />S~TUS ADDRESS:
<br />
<br /> 8?23 SHAW SQUARE ROAD
<br /> AuMSVILLE
<br />
<br />USE OF ~JILDING:
<br />
<br /> i 75300-720
<br /> ', CONSTRUCT~O~ ~VPE:
<br />
<br /> S ! CONTRACT CITY'. ! UGB'.
<br />OR 97325 ' :
<br /> t~AR~ON COUNTY ~, NO
<br />
<br />RESIDENTIAL
<br />
<br />PHONE, 384-2010 .~~<:j2~ O/-/'~' *-~ I
<br /> ~ SITE NUMBER: 2331
<br />
<br />LOT:
<br />
<br />WIDTH:
<br />
<br /> ~ VALUATION: $4, '144~ CO
<br />:BLOCK: !SECTION: ................. ~ I ~E: ' MAP:
<br />' ITOWNSHIP: I ~ ZONE: '
<br />
<br /> , 13 , BS ~, 2[~ ; A~3 49
<br /> O~PTH; AREA: ~ UNITS: ( IRREG. LOT; ~ CORNER:
<br /> 3.00000 ~ AC " NO [ NO
<br />
<br />TYPE: BUILDING PERMIT OR APPLICATION NO:
<br />
<br />CONTRACTOR, NO.
<br />BENJAMIN, PATRICK L.
<br />SAME
<br />
<br />PHONE: 364'--2010
<br />
<br /> ITEM
<br />BUILDING FEE
<br />PLAN REVIEW
<br />FLEET SURCHARGE -ZONE 2
<br />BUILDING STATE SURCHARGE
<br />ZONING SURCHARGE
<br />
<br /> 9004012
<br />ARCHITECT/ENGINEER, NO.
<br />
<br />PHONE:
<br />
<br />QUANTITY
<br />
<br />AMOUNT
<br /> $50.50
<br /> $32.83
<br />
<br /> $2.53
<br />
<br /> TOTAL A.S.SESS'ED ,' FE,E3S
<br /> · r,~PREM~,OUS: RECEIPTS ' $0, O0
<br /> $90.95
<br /> . .. '
<br />
<br /> $0.00
<br />
<br />PAYEE: BENJAMIN, PATRICK L. ,, , ,' Y 4561
<br />RECEIVED BY= DM ................ '3,..i,_ ~_~.~- "g RE,; 'OK CHECK ~; ?'002
<br />
<br />· THIS i8 NOT A PERMIT. THIS APPLICATION ,MDST'GO>'T,FI,,ROUGH A REVIEW PROCESS WHERE THE
<br />FOLLOWING MUST BE COMPLETED. IT IS ,_T, HE,_,.RESPONSIB~LITY' OF THE 'APPLICANT TO ASSURE THAT
<br />ALL NECESSARY I'NFORMATION HAS BEEN, ~ROV]:DED.: zO l~.,~
<br />
<br />CLAN REVIEW, ....... ,,--,X ',/;-- ,
<br /> 3ITY JURISDICTION: BY DATE
<br />
<br />SEPTIC: 8Y DATE
<br />7ONTNG: .BY ]~,,,~,-~;E ,~///',~_~ SETBACKS*-' FR'"-~.' :~
<br />
<br />OFFICE COPY
<br />
<br />PLAN. ACT l ON, ",
<br />
<br />
<br />
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