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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 />MARTIN, <br /> <br />SITUS ADCRESS <br /> <br />SIGNATURE OF APPLICANT <br /> DATE <br /> <br /> TAX LOT <br /> <br /> CONSTRUCTION TYPE <br /> <br /> 9218 STAYTON ROAD SE <br />AUIV~ViLLE OR 97325 <br /> <br /> CONTRACT CITY UGB <br />MARION O%)LINIy = NO <br /> <br />MAILING ADDRESS <br /> <br />SUBDIVISION <br /> <br /> CATEGORY <br /> RESt DEN IiAL <br /> <br />' OCCUPANCY <br /> <br /> OCCUPANT LOAD <br /> <br /> PHONE: ?69-5385 <br /> <br />LOT BLOCK SECTION <br /> <br /> TOWNSHIP <br /> <br />1 1 9S <br />1.5 AC <br /> <br />Si IE NUIVIBEN: 11725 <br />VALUA] I C~I: <br /> <br /> RANGE ZONE <br /> lW E~U <br /> NO NO <br /> <br />MAP <br /> <br /> 59 <br /> <br />IYPE: PL,UI~IN6 <br /> <br />CON fRACfOR NO. <br />MARTin, BE~E <br /> <br />PER'MIl OR APPLICAIION NO: <br /> <br />FI"tONE: ?69-5385 <br /> <br /> iIEM <br />WAFER LINES, 1sr lO0 FEEt <br />WA1ER LINSS. EA. AODL. lOB PEET <br />~ILE H(~'IE ~EWER ANO NAf~R CONNECI'[ON <br />PLEET 5URCRARGE -ZONE 3 <br /> <br />TOTAL A35~ED <br />PREVIOUS RECEiPI~ <br />'IHi$ RECEIPT <br /> <br />QUANI i fY AMOUN I <br />1 $20.00 <br />1 $1~.OO <br />~ $2s.0o <br /> <br />$88.84 <br /> $o_oo <br />$66.84 <br /> <br /> ~ BALANCE r..~E $0.00 <br /> PA~ES: M~RTIN, 8~iE ~\ RECEIPf NO: ~0396 <br /> <br />FOL~INB~ST 8E ~PLeTED. 1? I8 fHE R~SISILITY OF THe APPLI~"r TO ~R~ ~HAl <br /> <br />PLAN R~WIEN: BY DATE CiTY JURISDICTION: BY DAlE <br /> <br />REI'&~.RKS; WL/CONN R~4622 <br /> <br />~ORU, ~c 15-5~.EV 4m0 OFFICE COPY <br /> <br /> <br />