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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM. OREGON 97301 <br /> <br /> PHONE 588-5147 <br /> CODE-A-PHONE 4:30 P.M. - 8:00 A.M. <br /> <br /> am ~ registered builder OR the authorized representabve SIGNATURE OF APPL~CAN ' ,¢----~~,~,~ ¢ ,~-~, <br /> <br /> of a registered builder. <br />The work wlll be performed by a registered builder. <br />Other , ,, <br />I have re~.td and agree to the terms Stated on the reverse side of DATE: <br />th~S document. <br /> <br />DATE; 07/07/88 TIME.* 11: 05 ;45a <br />OWNER: : TAX LOT: <br /> ! RES I DENT ,( At,.. <br /> BEILSTEIN, JOHN <br />~HUS ADDRESS: .. : CONSTRUGTIQN TYPE; <br /> <br /> 8763 ~AW ~UARE RD SE ~ CONTRACT CITY'. ~ UGh: ¢OOCUPANT LOAD: <br /> <br /> AU~V[ LLE OR 9?325 , <br /> ~ ~.._C~N~ ~ -...L-..- :NO <br /> <br />MAIL~NG ADDRESS: SINGLE FAMILY DWELLINGS !SUBDIViSiON: <br /> <br /> SAME <br /> <br /> PHONE: 585-6966 <br /> <br />LOT: BLOCK; <br /> <br />W{D'fR: DEPTH: <br /> <br /> SITE NUMBER: 4851 <br /> VALUAT I ON: <br /> ~ZONE; <br /> <br />TYPE: BUILDING <br /> <br />CONTRACTOR, NO. <br />BEILSTEIN, JOHN <br />SAME <br /> <br />PHONE; 585-6966 <br /> <br />PERIVliT OR APPLICATION NO: 9009574 <br /> <br /> ARCHITECT/ENGINEER, NO, <br /> <br />PHONEt <br /> <br /> ITEN <br />BUILDING FEE <br />PLAN REVIEW <br />FLEET SURCHARGE -ZONE 2 <br />BUILDING STATE SURCHARGE <br />ZONING ~RCHARGE <br /> <br />TOTAL ASSE:S,SEO FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY <br /> <br />AHOUNT <br /> $74.50 <br /> $4.8.43 <br /> ~2.56 <br /> 3_?3 <br /> <br />$132.95 <br /> $0.00 <br />$132.95 <br /> <br /> 8AL~AN~E DUE SO_C0 <br />PAYEE: JON BEILSTEIN I.'",~ 1024~ <br />RECEIVED BY: XXX ............................ ~_'b./_~'2L-~__ TYPE: CK CHECK ~: 4501 <br /> <br />~ THIS IS NOT A OERf~4IT, THIS APPLICATION ~JST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST BE CQHPLETEO. IT IS THE RESPONSIBILITY OF THE' APPLICANT TO ASSURE THAT <br /> <br />ALL NECESSARY <br /> <br />PL~ REVIEW: BY <br /> <br />HAS BEEN PROVIDED. <br /> <br /> CITY JURISDICTION; 3Y <br /> <br /> DATE <br /> <br />ROOM ADDN <br /> TOTAL SO FT: 480 STORIES: 1 PLAN_ACTION: <br /> <br />SEPTIC: 8Y <br />ZONING: <br /> <br />HEIGHT; <br /> <br />F-OMM 'I Mi'; r!~-!m ~V. ~¢~ OFFICE COPY <br /> <br /> <br />