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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 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />lamareglsteredbullderOR( ) the authorized representative <br />of a registered builder, <br /> <br />Other <br /> <br />I have read and agree to the terms stated on the reverse side of <br />this document. <br /> <br />SIGNATURE OF APPLICANT: <br /> DATE: <br /> <br />OWNER: <br /> ",.(]Al' E: 05/22/'90 TIME: <br /> <br />snus AODSES~Uf"f'ER' RALPH <br /> <br />TAX LOT; <br /> <br />CONS~RUO¥~ON TYPE: 99012~0]'~ <br /> <br />CATEGORY: <br /> <br />OCCUPANCY: <br /> <br />RESIDENIIAL. <br /> <br /> 855 CLEVELAND <br />USE &M~'~.~C~,~E OR 9?325 <br /> <br />SINGLE FAFIiLY L~'~ELLING~ <br /> <br />PO ~30X 12533 <br />SALEM OR 9?309 <br />PHONE: 588,-237'3 <br /> BLOCK: <br /> <br />AUI'4SV i LLE <br />~tJ~mvisi0~; <br /> <br />NO <br /> <br />TOWNSHIP: <br /> <br />AU~VILLE MEA~ <br /> <br /> GCALUA.FiON: ZONe: <br /> <br />WIDTH: DEPTH: AREA[ UNi+S: IRREG. LOT: COSNER: <br /> 2 1 25 8S 2N F~ 51 <br /> <br /> '~ i00 ~ouu. ~c N~ I~ <br /> <br />3 <br /> <br />TYPE: BUiLDiNG PEI;~II'T' OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. 43505 <br />F~LPH SU'f'TER <br />PlO BOX 12533 <br />SALP2'4 97309 <br />PHONE: 588~2373 <br /> <br /> Fl'EM <br />BUILDING FEE <br />PLAN REVIEW <br />FLEET SURCHARGE -ZONE 3 <br />BUILDING ~'fA'f'E SURCHARGE <br /> <br /> 9024242 <br /> <br />ARCH i ]'ECT/ENf3I NEER, NO. <br /> <br />PHONE= <br /> <br />OUAN! 1' '¥ <br /> <br />AC4OUN'T' <br /> <br /> 134.23 <br /> $3,84 <br /> $~o.33 <br /> <br />TOTAL~F-"SSED FEES $354.90 <br />PRE¥iOtJS RECEZP'rs $0.00 <br />]'HI8 RECEIPI' $354.90 <br /> <br />BALANCE 0ME $0-00 <br /> <br /> PAYEE: RAL. PH ~Ut'IER ~ 25688 <br /> RECEIVE0 ~Y: P'8 JO} TYPE-=. iN CHECK ~- 0 <br /> <br />~ 'f'HI~ i5 NOT A PE~I'T. ~HI~ APPLICA'¥i~ ~s'r ~ TH~U~ A REVI~ P~E~ ~ERE THE <br />POLLOWiNG ~S'l' BE COMPLETED. iT iS THE RES~SiBiL~'f'Y OF THE APPLICANT TO A~URE I'HAI <br />ALL NECE~ARY INF'O~'ri~ H~: BEEN P~V~DED. <br /> <br />~EPTIC: 8Y .................................. DATE .............................................. <br /> <br />ZONING: ~Y DATE <br />REMARKS: N'E'~"RES ............................................... <br /> <br />HE[GHI: /4 TOT'AL ~ F'I': <br /> <br />SE[BACKS: FR,..20 LS....5 RS 5 RR 5 5P ............ <br /> <br />1395 STORIES: 1 PLAN.ACTION: <br /> <br /> OFFICE COPY <br />FORM # MC 15-56 REV. 4190 <br /> <br /> <br />