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220 HIGH STREET N~ <br />SALEM, OREGON 9'7301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:;30 PM - 8::00 AM <br /> <br />I am performing work on 8 property ~ own or occupy <br />l am a registered builder OR ( itheauthorizedrepresentatlve <br />of a registered builder <br />fhe work will be performed by 8 reg*stered builder <br />Other <br /> <br />DATE: 06/1 ?/8~/ TIME: 4:08::34~ <br /> <br />SIGNATURE OF APPLICANT <br /> <br /> DATE <br /> <br />OWNER CITY OF' AUMSVILLE TAX LOT CATEGORY 0 <br /> <br />~ITUS ADDRESS CONSTRUCTION TYPE OCCUPANCY <br /> <br /> 1200 M~,IN ST <br /> AUMS¥ILLE OR 97325 CONTRACT CITY UGg OCCUPANT LOAD <br /> AM <br /> <br />MAILING A~DRESS <br /> <br /> PO BOX 22? <br /> AUMSVILLE OR 9?325 <br /> PHONE: ?49-2030 <br /> <br />LOT <br /> <br />WIDTH <br /> <br />SITE NUMSER= <br /> VALUATION: <br /> <br />1812 <br /> <br />N <br /> <br />$936.00 <br /> <br /> MAP <br /> <br />TYPE= BUILDING PER~IT OR APPLICATION NO.- <br /> <br />CONTRACTOR, NO. 81891 <br />QS.SENKOP CONSTRUCTION <br />1255 BOONE RD SE APT 56 <br />SALEJVl OR 9?302 <br />~'4ON8~ 58]--?]22 <br /> <br /> ITEM <br />BUILDING F'EE <br />FLEET SURCHARGE <br />STATE SURCHARGE--~ <br /> <br />2614 <br /> <br />ARCHITECT/ENGINEER, NO. jfv~ <br />JMS ENGINEERING <br />1810 LANA AVE NE SUITE I <br />SALEM OR 97301 <br />PHONE: 585-5578 <br /> <br />QUANTITY <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />AMOUNT <br /> Si?so <br /> ~8.84 <br /> <br />$22,04 <br />$22.04 <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE: INVOICE NO~ <br />RECEIVED BY: OM TYPE: CHECK <br /> <br /> THIS IS A VALID PEi~fllT * THIS PERMIT EXPIRES 180 DAYS FROf,1 ITS I,%.SUE DATE. IF <br />CONSTRUCTION CEASES. FOR A PERIOD OF 180 DAYS, OR IF CONSTRUCTION FAIL~ TO ~EET ALL <br />EF.~JIRE~E~TS OF STATE LAhlS ~¢4D MARION COUNTY BUILDING AND ZONING ORDINANCES, THIS PERf~IT <br />E~ALL BECOME NULL AND VOID. <br /> <br />SETBACKS: FR- LB- RS-., RR~ BP- <br />RE~RKS: PICNIC SHELTER ~ MIdC~,O~EE-~-PARK ~., <br />HEIGHT: TOTAL SO FT: .... '0 ~IOP~E.S~; PLANNING ACTION: .! ~ ~' <br />DONALD E. ~K]ODLEY, MARION C~NTY 8UIED~NG OFFIC~AL / 8Y .......... ~gL_. ~ <br /> <br />OFFICECOPY <br /> <br /> <br />