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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 NtlGH S~-REET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: B88-B147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />Other_ <br /> <br />SIGNATURE OF APPLICANT; <br /> DATE; <br /> <br />ow~)~:~'~: 19/t0/90 't't~E~ 15:48:49 <br /> <br /> Ct'f'Y OP' AUI~SV~LLE <br />SITUS ADDRESS; <br /> <br /> 955 OLNEY <br />AUI'4SVI LLE OR 97325 <br /> <br />"AX LOT: CA'f EGORY. <br /> <br /> CO~¢4ERC i AL <br />CONSTRUCTION TYPE: OCCUPANCY: <br /> <br />UA~L~N~ ADDRESS: S'fRUC'f'OIR~S bTHER THAN BUILOIN~ SUBD~WS~ON: <br /> <br /> F~ BOX 29? <br /> AUI"4~ViLLE 9?325 <br /> PHONE: SZ']'E NUMBER: <br /> VALUATJO'N: <br />LOT: ! ~LOCK: SECTION: TOWNSHI¢: ' RANGE: <br /> <br />ZONE: <br /> <br />3450 <br /> $500.00 <br /> MAP: <br /> <br />1125, 2200 ! 24750Q0. ~F NO i NO <br /> <br />TYPE: BUiLDiNG <br /> <br />C~N'f'RAC'f'OR, NO_ <br />CITY OF AU~SVILLE <br />PO BOX 22? <br />AUMSVILL. E 9732~ <br />PHO1NIE: <br /> <br />P~RM~'T' OR APPLICATION NO: 9027910 <br /> <br /> ARCHi'rEc'f'/ENG~NEER, NO, <br /> <br /> ~fE~ <br />BUiL_DiNG FEE <br />PLAN REVIEW <br />FLEEI' SUP~;HARGE -ZONE 3 <br />BUILDING STATE SURCHARGE <br /> <br />PHONE: <br /> <br />TOTAL ASS~ED <br />PREW i OUS RECD.!, ~'f'S <br />THIS RECEIPT <br /> <br />(~UAN T t '1'Y <br /> <br />AMOUNt' <br /> $10,00 <br /> ~5.50 <br /> 3.84 <br /> $0_50 <br /> <br />$20+94 <br /> <br />$20.84 <br /> <br />BALANCE glUE $0,0~ <br /> <br />PAYEE: C~'[Y OF AuIvr~ViLLE 29503 <br />RECEIVED BY: PR TYPE: IN CHECK ~; 9 <br /> <br />~ 'f'l,,fi~ iS NOT A PERIVlI'f'. THiS APPLICA'rION MUST GO THROUGH A REYJ;E~ PROCE~ WHERE THE <br />FOLLOWING ~U~'~' BE COMPLE'I'BO. iT iS THE RESPONSIBiLi'T:Y OF THE APPLICANT fO AS~RE TRAT <br /> <br />ALL NECE~RY iNFORMATiON HA~ BEEN PROviOEO. <br /> PLAN REV1EW: B/~ ......... OATE.//:~?,,~,,~: ...... <br /> SEP'f'[C: BY OATE <br /> <br /> ZONING: BY OAfE 8E'I'BACK~: <br /> REMARKS: COR'f'A~NRE~'f' <br /> <br />HEiGH'¥': TC)I'AL ~ F'I': 0 <br /> <br />CiTY JURiSDJC]'ION: BY DATE <br /> <br />FR L5 RS RR SP <br /> <br />S!OR~ES~ <br /> <br />PLAN.ACT'iON: <br /> <br /> OFFICE COPY <br />~ORM # MC 15-58 REV. 4/90 <br /> <br /> <br />