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220 HIGH STREET NE <br />SALEM, OREG.ON 97,301 <br /> <br /> PHONE 588-$147 <br />CODE-A-PHONE 4:30 P.M. - 8:00 A.M, <br /> <br />I am performing work on a property I own or occupy. <br />l am a registered builder OR ( ) the authorized representative <br />ol a registered builder, <br />The work will be pertormed by a registered builder. <br />Other. <br /> <br />I have read and agree to the terms stated on the reverse side of <br /> <br /> DATE: 02/26/88 <br />OWNER[ GAUTH I ER, <br /> <br /> 810 7TH ST. <br /> AUMSVI LLE <br /> <br />MAlt lNG ADDRESS: <br /> <br /> SAME <br /> <br /> PHONE: 749-2932 <br /> <br /> TIME: 12:02;28p <br /> ~ T~X Lof; <br />PETER & KAREN ~ <br /> <br /> CON~TRUSTION TYPE: <br /> <br /> ~ OON~RAC~ ~ITY'. <br /> OR 9?325 ~ u~: <br /> ~VI LLE I NO { <br /> <br />FA'I"~ OAKS ESTATES <br /> <br />SINGLE FAMILY D~ELLIN6~, <br /> <br />LOT: j BLOCK: <br /> 18 <br /> <br />TYPE: BUILDING <br /> <br />CONTRACTOR, NO~ <br />GAUTHIER, PETER & KAREN <br />SAME <br /> <br />SITE NUMBER: <br /> VALUATION: <br /> <br />; CATBGORYZ RESIDENTIAL <br /> <br />, OCCUPANCY: <br /> <br /> OCCUPANT LOAD: <br /> <br />~--~7~.200.00 <br /> <br /> 'SECTION: i~OWNS'HI~: iR~N~: ZONEi <br />3 25 8S ~ 2W RS <br /> <br /> 95 ; 7695.00 ~ SF i <br /> <br /> PERMIT OR APPLICATION NO: C9006949'"~ <br /> ARCHITECT/ENGINEER, NO. <br /> <br />PHONE: 749-2932 PHONE: <br /> <br /> ITEM <br />BUILDING FEE <br />PLAN REVIEW <br />FLEET SURCHARGE -ZONE <br />BUILDING STATE SURCHARGE <br /> <br />::,PREVIOUS:RECEIPTS <br />' THIS"RECEIPT <br />~::::8AfLANCE DUE <br /> <br />QUANTITY <br /> <br />ANOUNT <br /> $122-50 <br /> $79.63 <br /> ~3.84 <br /> 6.13 <br /> <br />$212.10 <br /> $0.00 <br />$212.10 <br /> <br />PAYEE= GAUTHIER, PETER & KAREN ~' ' ~ ?583 <br /> <br />~ THIS IS NOT A PEI~,IIT. THIS,APPUIOATION,:~'4UST,G0;::TH~([~ AREVIEW PROCESS WHERE THE <br />FOLLOHING IvEJST BE COMPLETEO. IT [STHE~,".REE, PONSIB~IE:I'I~',OFTHE APPLICANT TO ASSURE THAT <br />ALL NECES,,SARY INFORfC, ATION HASSEEN PROVIDED~ <br /> <br />PLAN REVIEW: .... BATE <br /> CITY JURLSDI~YION: BY ........ DATE <br /> <br />SEPTIC= BY DATE <br />ZONING: BY DATE SETBACKS= FF~'20 <br /> <br />RE~RKS: FAM.P~,/BATH,/BBR~ ADDITION <br />HEIGHT: 12 TOTAL SQ FT: 540 <br /> <br />LSd16 ~5 RR-5 BP- <br /> <br />STORIES; 1 PLAN,ACTION: <br /> <br />OFFICE COPY <br /> <br /> <br />