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MARION COUNTY BUILDING INSPECTI@N <br />SENATOR BLE)G, NO, 225 <br />2'~0 HIGH STREET NE <br /> SALEM, OREGON 97'301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> lam performing work OR a¢roC~ertylow" o, ocoupy. ~'~/~.~1 ~ ~ , ~ ~-- <br /> I am a registered b~Jilder OR ( ) the authorized representative SIGNATURE O¢ APPLfCANT: <br />) of 8 registered buflder, <br /> <br />DRY, DAVE <br /> <br /> 5983 NALINA COOR'r <br /> AU~VILLE <br />USE O¢ SUILDING; <br /> <br />OR 97325 <br /> <br />SE <br /> <br /> RES1 DEN ¥' IAL <br /> CONTRACT CITY. ~B: OCCUPAN1 L~'A~~ <br />MARION COLINI'Y NO NO Ok B~LIHOUM5 <br /> <br />MAILING ADDRESS SINGLE FAMILY DNELLiNE75 <br /> <br />SUBDIVISION: <br /> <br /> 3 <br /> <br />ROELtNGGREEN ~'FAI'ES WEST <br /> <br />LOT <br /> <br />SITE NUMBER: 10585 <br />n~N~EVALUATION: ZONE $59'910~00MA~ <br /> <br />155 412 <br /> <br />~3 =: EG. LOT. 2~ CORNER AR <br />SF YES NO <br /> <br />4g <br /> <br />TYPE: BUiLDiNG <br /> <br />PERMIT OR APPLICATION NO: <br /> <br /> ITEM <br />BUILDING FEE <br />PLAN RE¥iEW <br />FLEET SLIr~HAtk~E -ZONE 3 <br />BUILDING STATE SURCHARGE <br />ZONING ,?SURCHARGE <br /> <br /> 9026?59 <br />AR'CHiI'EC'f/ENGiNEER, NO. <br /> <br />PHONE <br /> <br />TOTALASS~ED FEE~ <br />PRb~/IODS RECEIPTS <br />THIS RECEIPT <br />BAL.N~CE DUE <br /> <br />PAYEE: RANDY FUL'f'Z CONSTRUCTION <br />RECEIVED BY: c"l TYPE: CK <br /> <br />OUANT'ITY A~JUN1 <br /> $313.00 <br /> $203.45 <br /> $3.84 <br /> 15.65 <br /> 15.65 <br /> <br /> $551.59 <br /> $o.oo <br /> $551.59 <br /> <br /> $0.00 <br /> <br /> 28308 <br />CHECK ~: t585 <br /> <br />THiS iS NO1A PERf4iI'. ,'THIS'APPLICATiON I~!UST GO THROLIC-~ A REVIEW PROCE~ NHERE '}'HE <br />FOLLOWING M~J~f BE COMPLE'fEO. iT IS THE RE~PONS[BIL'iTY OF THE APPLICANT 'fO ~RE THAI' <br /> <br />ALL NECE~RY INFORMATION HAS BEEN PROVIDED+ <br /> <br /> .......... .......... <br /> <br />HEIGHT: 15 'TOTAL ~ FII': 2060 <br /> <br />CiTY JURiSDiCTION: BY ............................. DATE .................................. <br /> <br /> LS,,,Z .... .... s, ................ <br /> <br /> PLAN.ACTION: <br /> <br />OFFICE COPY <br /> <br /> <br />