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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG NO 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97;301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 PiM- 8:;00 A Mi <br /> <br /> DATE: 06/09/8? TIME: 4:02:23p <br />OWNER CITY O¢ AUMSVILLE <br /> <br />SIGNATURE OF APPLICANT <br /> <br />TAX LOT <br /> <br /> SITUS ADDRESS CONSTRUCTION TYPE ,, <br /> <br /> AUIv~VILLE OR 9?325 CONTRACT CITY UGB <br /> AM <br />USE OF BUtLDINC <br /> <br />CATEGORY <br /> <br />OCCUPANCY <br /> /4-1 <br />OCCUPANT LOAD <br /> <br />O <br /> <br />NO OF BEOR00M$ <br /> <br />MAILING ADDRESS SUBDIVISION <br /> <br /> PO BOX 22? <br /> AUNSVILLE OR 97325 <br /> PHONE; ?49-2030 SITE NUMBER: 1613 <br /> VALUATION: $936.00 <br /> <br />LOT BLOCK SECTION TOWNSHIP RANG~ ZONE MAP <br /> <br />WIDI'H DEPTH AREA UNITS IRREG LOT ~ CORNER N <br /> <br />TYPE: BUILDING PERI'4IT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. 31891 <br />OSSENKOP CONSTRUCTION <br />1255 8CONE RD SE APT 58 <br />SALEJ~ OR 9?302 <br />PHONE: 581--7122 <br /> <br /> ITF_~ <br />CUILOING FEE <br />FLEET SURCHARGE -ZONE <br />STATE SURCHARGE <br /> <br />PAYEE: OSSSENKOP CONSTRUCTION <br />RECEIVEI3 BY: CR <br /> <br />9002614 <br /> <br />ARCHITECT/ENGINEER, NO. JMS <br />JI~S ENGINEERING <br />1810 LANA AVE NE SUITE 1 <br />SALEN OR 97301 <br />PHONE: 585-55?9 <br /> <br />OUANTiTY <br /> <br />TOT&L ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />AIv~OUNT <br /> $17.50 <br /> $3.84 <br /> $0.70 <br /> <br /> $0.00 <br />$22+04 <br /> <br />BALANCE DUE $0.00 <br /> <br />INVOICE NO: 3124 <br />TYPE: IN CHECK ~: 0 <br /> <br />· THIS IS NOT A PE~4IT. THIS APPLICATION ~JST ~ THROUgh-{ A R~VI~ PROCESS t~rleRE THE <br />FOLbONING HUST BE CONPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFOI~TION HA~ BEIB~ PROVIDED. <br /> <br />PLAN <br /> REVIEW; <br /> <br /> CItY JURISDICTION, 8Y ........ DATE .......... <br />SEPTIC: BY BATE <br /> <br />R~AR~: <br /> TOTAL <br /> ~ ~:~0 STORZES:' PLANNZNG ACTZON: <br />HEZGHT: <br /> <br />OFFICE coPY <br /> <br /> <br />