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MARION COUNTY BUILDING INSPECTION <br />SENATORBLDG NO 295 <br />.220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE:: 588-514'7 8::00 - 4::30 <br />24 HOUR CODE-A-PHONE:: 588-7904 <br /> <br />DA"FE: 12/18/'90 I'iN~: 1:9:54:11 <br /> HgRRiV)ANN, ROY <br /> <br /> 92?3 SHAW bQUARE RD <br />AUMSVI LLE OR 97325 <br /> <br />SIGNATURE OF APPLICANT <br /> <br /> TAX LOT <br /> <br /> CONSTRUCTION TYPE <br /> <br /> CONYRACT CITY <br />¢4¢.R i ON ~NrY <br /> <br />DATE <br /> <br />SUS01VlSION <br /> <br />UGB <br /> <br /> NO <br /> <br />DE~IREE HERRMANN - t~.,'~iLE OWNER <br />9254 5HAW ~E RD SE AUI~SV1LLE <br />PHONE: 364~1933 <br /> <br /> ~iTE NUI~I~BER: <br /> VALUA'f' i GiN: <br /> <br />TOWNSHIP RANGE <br />UNITS ~ IR~EG LOT NO <br /> <br />CATEGORY <br /> RE~51 DEN I IAL <br /> <br />OCCUPANC¢ <br /> <br />OCCUPANT LOAD <br /> <br /> 11810 <br /> <br />ZONE MAR <br /> AR3 4,9 <br /> <br />IYPE: PLUIW~ I NG <br /> <br />P~I1 OR APPLiCAIION NO: 9029400 <br /> <br />CONTRACTOR, NO. <br />HERRMA~N, F~OY <br />O~IREE H~-RRMANN - MO~ILE O!~ER <br />9254. 5H/8¢1 ~ARE RD ~E ~ViLL <br /> <br />1 <br />~rER LIN~, I~T 100 <br />~,I'ER LIN~, EA. ADOL, 100 FEEl <br />B~ER LiN~, I~T 100 FEET <br /> <br />~IL~ H~E SEWER ~D ~TER ~NECTi~ <br />PLUMING ~'fA7 E <br /> <br /> c~ r I TY AC4OUN I <br /> 1 $20.00 <br /> 2 $30. oo <br /> I ~3o. oo <br /> 2 33o.oo <br /> 1 $25.00 <br /> $3.84 <br /> $6.75 <br /> <br />TOTAL A,5~EU FEES $1~,5.59 <br />PREV i~ RaCal P'I'S $0.00 <br /> <br />8A~OE ~a $0. oo <br /> 31064 <br /> <br /> * THIS I5 NOT A PERI~IlTo THIS APPLICATION I~L~T GO THROdGH A ~I~ ~ ~E~ THE <br />~L~I~ ~T BE ~PLETEO. IT 18 TH~ ~5iBILITY OF THE APPLIC~T TO ~RE T~T <br />ALL N~ INFO~TI~ H~ BE~ P~I~D. <br /> <br />PLAN REVIE3N: iCY ....... DA"rE .................. <br /> <br />REIV~RY¢5: W/~ CONN, W/~ LINE'S 300' EACH <br /> <br />city JURISDICI'ION: ~ly .......... r.,IAIE ........ <br /> <br />OFFICE COPY <br /> <br /> <br />