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MARION COUNTY BUILDING INSPECTION <br /> SENAcTOR BLDG, NO, 225 <br /> ~ 220'-HIGH STREET NE <br /> SALEM ~REGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4::30 EM - 8,00 AM <br /> <br /> I am performln(i ¢Vork on a property I own o¢ occupy <br /> I am a regmtered builder OR ( I the authonzed repre~ontative <br /> of a rog~stered builder <br /> The woPk ~dl be performed by a reg~,~tored builder <br /> Other <br /> I have read and agreo to the terms stated on the revorso side of <br /> ~SiS document <br /> <br />DATE: 03/16/89 TIME** 10:48:25a <br /> DORAN, TOM <br /> <br /> 885 8TH <br />AUMSVI LLE OR 97325 <br /> <br />SIGNATURE OF APPLICANT <br /> <br /> 90040-350 <br /> 5-N <br />ADMSV I LLE YES <br /> <br /> SINGLE FAMILY DWELLINGS <br />MAiUNG ADDRESS <br /> <br />PO 8OX 185 <br />SUBLIMITY, OR 9?385 <br />PHONE: 769-7364 <br /> <br />LOT BLOCK <br /> <br /> 22 5 <br />WIDTH DEPTH <br /> 74 100 <br /> <br />DELMAR I I I <br /> <br /> SITE NUMBER: <br /> VALUATION: <br /> <br /> 25 89 2w <br />?400.00 SF NO <br /> <br />RES I DENT I AL <br />R-3 <br /> <br /> 6750 <br /> $32,500.00 <br /> <br /> RS <br /> <br />NO <br /> <br />TYPE: BUILDING <br /> <br />CONTRACTOR, NO. <br />TOM [)DRAN <br />PO BOX 185 <br />,,gUBLIMITY 9?385 <br />PHONE: 759-7364 <br /> <br /> PERMIT OR APPLICATION NO: 9014599 <br /> <br />55493 ARCHITECT/ENGINEER, NO. <br /> <br /> ITEM <br />BUILDING FEE <br />PLAN REVIEI~ <br />FLEET SURCHARGE -ZONE S <br />BUILDING STATE SURCHARGE <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY <br /> <br />AMOUNT <br /> $206.50 <br /> $134.23 <br /> $3,84 <br /> $10.33 <br /> <br />$354.90 <br /> $0.00 <br />$354.90 <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE: TOM BOP. AN ~ 154'74 <br />RECEIVED BY: Or ~ .... ?OPE: IN CHECK ~: 0 <br /> <br />* THIS IS NOT A PERMIT. THiS APPLICATION MUST GO THROUGH A REVIEW PROCESS HERE THE <br />FOLLOWING MUST BE COMPLETED. IT IS THE RES~NSIBILZ~ OF THE APPLICANT TO ASSURE THAT <br />ALL NEC~RY INFO~TION H~ 8E~ P~VIDED. <br /> <br />SEPTIC: 8Y <br />ZONING: BY <br /> <br />REMARKS: NEW RES <br />HEIGHT: 14 <br /> <br /> CITY JURISDICTION: BY <br /> <br /> DATE <br />DATE ........ SETBACKS: FR-20 LS-5 ~S-5 RE-5 <br /> <br />TOTAL SQ FT: 1328 STORIES: I PLAN.ACTION: <br /> <br />DATE .......... <br /> <br />OFFICE COPY <br /> <br /> <br />