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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 />{: I am performing work on a property I o¢~n or occupy <br /> <br /> ) Other <br /> <br /> DALE: 10/16/90 FI~E: 14:21:09 <br /> <br /> KEf FLER, CHUCK <br /> <br />51IUS ADDRESS <br /> <br /> 7015 AUF4SVILLE HIC44WAY <br />AU~GVILLE OR 97325 <br /> <br />M~ILING ADD R ES,~ <br /> <br />SINGLE F.aCaILY D~AIELLINf.~ <br /> <br />PHONE: 581-5087 <br /> <br />SIGNATURE OF APPLICANT <br /> DATE <br /> <br /> TAX LOT <br /> <br /> CONSTI=DCTIO N TYPE <br /> <br /> CONTRACT CITY <br />I~IAR I r0N COUN fY <br /> <br />LOT BLOCK SECTION TOWNSHIP <br /> 15 85 <br /> <br />WIOTII DEPTH A~EA 3. UNIIS AC <br /> <br />5?325/5?'324 <br /> <br />5-N <br /> <br /> NO <br /> <br />SII'E NUI~BER: <br /> VALUAIION: <br /> <br />~ANGE <br /> <br />II~REG LOT NO <br /> <br /> 10681 <br /> <br />ZONE MAP <br />AR <br /> <br />1YPE: BUILDING PERt411 OR APPLiCAIION NO: <br /> <br />CONf'f~AOTOR, NO. 42185 <br />B.G. ANDERSON CONSf INC <br /> ,108 V~'fURA AVE N <br /> <br />PHONE: 393-5295 <br /> <br />BUiLOiNG <br />PLAN REVieW <br />FLEE[ ~AJRCHARGE -£~ 8 <br />BUILDiNG ~IAIE ~AJRCHAR~E <br />ZONING SURCHARGE <br /> <br />PAYEE: E.G. AND~F*i~r..,~ CONSF iNC <br /> <br /> 9028069 <br />ARCHiIECT/ENGiNEER, NO~ <br /> <br />iOfAL ~ED FEES <br />PRE~IOUS RECEIPTS <br />THIS RECEIPI <br /> <br />QUANIifY <br /> <br />$26.73 <br />$3.84 <br /> <br /> $2_83 <br /> <br />$102.73 <br /> $0.00 <br />$102.73 <br /> <br />BALANCE DUE <br /> <br />29654 <br /> <br /> RECEI¥~D BY: CL TYPE: CK CB~CK ~: 585 <br /> <br />~ lHI~ iS NOI A PbF~vII[. FBiS APPLICATION MU~T GO rHROUGH A Rh~FiEN PROC~,.4~ ~ERE FHE <br />FOLLOWING r4ust BE COMPLEIEO, IT iS 1HE RESPONSIBILITY OF THE APPLICAN! 10 ASSURE ]HAl <br />ALL NF__cC~RY INFON~tAf'!ON HA~ BEEN PROVIDED. <br /> <br />SEPI'IC: BY DATE <br /> <br />REMARKS: ~F ALfERNAI'iON ON ~R R~c4208 <br /> <br />HEiGHI: 8 IOIAL SQ F'I: 0 <br /> <br />cc <br /> <br />CIIY JURISDICflON; BY DAIE <br /> <br /> FR f <br /> <br /> DfORi~: 1 <br /> <br />OFFICE COPY <br /> <br />LS RS '7;. <br /> PLAN _ ACI ION: <br /> <br /> <br />