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I am a re~istered builder OR ) the authorized representative <br /> <br />The work will be performed by a registered builder. <br />Othe¢ <br /> <br />MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, ORF~GON 97301 <br /> <br /> PHONE 588-5147 <br /> CODE-A-PHONE 4:30 RM. - 8:00 A.M. <br /> //__ <br /> SiGNATORE OF APPLICANT; ,.,J'~'J~J~"~'~ -- <br /> <br />DATE: <br /> <br />MALLING ADDRESS: <br /> <br />1:52:17p <br /> <br />DATE: 07/19/89 TIME: <br /> <br /> ST MARYS PARISH ?5300-270 <br /> <br /> 9168 SILVER FALLS HWY SE CON?RACYOITY: <br />AUI'~SV I LLE OR 97325 <br /> MARION COUNTY NO <br /> <br /> CHURCHES AND OTHER RELIGIOUS BUILDINGS <br /> <br />CAT6GOR¥' <br /> COfV~4ERCI AL <br /> <br />oo~: ? <br />ooog PANT LOAD: <br /> <br />NO OF GEDROOMS: <br /> <br />ED SH EEHAN <br />3896 CLOVERDALE DR SE TUI;~4ER 97392 <br />PHONE: 743-2097 <br /> <br />LOT: BLOCK: <br />WIOTH: DEPTH; <br /> <br /> SITE NUMBER: <br /> VALUAT I ON: <br />SECTION: ~WNSHIP: RANGE. <br /> <br /> 13 8S 2N <br />AR~A; UNITS: IRREG. LOT: <br /> NO <br /> <br /> 2578 <br /> $10,945.00 <br />ZONE: MAP: <br /> <br /> AR8 49 <br /> NO <br /> <br />TYPE: BUILOING PERMIT OR A~PLICATION NO: <br />CONTRACTOR, NO. 43845 <br />BLAYLOCK ROOFING .~/Y <br />9467 STAYTON RD SE~' ~' / ' <br />AUMSVILLE OR 97325 ~ <br />PHONE~ 789-6187 <br /> <br /> ITEM <br />BUILDING FEE <br />PLAN REVIEW <br />FLEET SURCHARGE -ZONE 3 <br />BUILDING STATE SURCHARGE <br /> <br />PAYEE: BLAYLOCK ROOFING <br />RECEIVED BYt OM <br /> <br /> 9017507 <br />ARCHITECT/ENGINEER. NO. <br /> <br />IOTAL ASSE,,%$.ED',FEES <br />PREVIOUS RECEIPTS <br />TH~S RECEIPT <br /> <br />BALANCE'DUE <br /> <br />QUANTITY <br /> <br />AIviOUNT <br /> 86.50 <br /> 56.28 <br /> $3.84 <br /> $4+33 <br /> <br />$150.90 <br /> $0.00 <br />$150.90 <br /> <br />$0.00 <br /> <br /> 18611 <br />TYPE~, CK CHECK ~: 2228 <br /> <br />~ THIS IS NOT A PERMIT. THIS ,APPLICATION: MUST'GO THROU~ A REVIB4 PROCESS t,~4ERE THE <br />FOLLOWING MUST BE CONPLETEB.,'"~!IT~:,'[S~,THE ~ESPONSIBILITY OE THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFO,RfflA/T.41ON HAS, BEEN,PROVIDED. <br />PLAN REVIEW, B: ..... <br /> <br />SEPTIC: BY DATE : <br />ZONING.' BY BATE SETBACKS: <br /> <br />REMARKS: RE-ROOF CHURCH R~$989 <br />/,,, TOTAL <br /> <br />CITY JURISDICTION: BY ........ DATE <br /> <br />O STORIES; PLA~.ACTION.+ <br /> <br />OFFICE COP': <br /> <br /> <br />