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MARI(iiCOUNTY BUILDING INSPECTIQll/~ <br /> SENATOR BLDG. NO. 225 ~I~ <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 />] am a registered builder OR( ) the authorized representative SIGNATURE OF APPLICANT: <br /> <br />of a registered builder, <br />The work will be berformed by a registered builder. <br />Other. <br /> <br />I have read and agree to the terms stated on the reverse side of <br />this document, <br /> <br />¢~°w~'/~f'E: 08/30/80 'riME_- ~O_-4~-_,~'Z <br />~,ITUS ADDRE~:~;[ LLER, JERRY <br /> <br />CONSTRUCTION TYPE OCCUPANCY. RESiDEN l iAL <br /> <br /> 9:~37 SILVER FALL~ B~rf <br />u s~A~N~E OR 97325 <br /> <br />MAIL~NG ADDRESS <br /> fgf'RUC f'U RF...~ O'~2 BU ILDiNG~ <br /> 435 N- MACY ST <br /> MC.~IINNViLLE, OR 9'1128 <br /> PHONE.* 4'12-'1618 <br />LOT: BLOCK SECTION TOWNSHIP: <br /> <br />CONTRACT CITY 5,,.JI~B OCCUPANT L~i <br />¢4ARiON ODUNTY NO NO o~: <br />SUBDIVISION <br /> <br />$iI'E NUtCr~ER: 31075 <br />.A~N~aI_UA'F i ON: ZONE <br /> <br />WIDTH. DEPTH: AREA 1 3 <br /> <br />UNITS <br /> <br />BS RREG LOT 21~ CORNER. <br /> <br />49 L~ <br /> <br />TYPE= BUILDING PEf-aVlIT OR APPLICATION NO; 9026862 <br /> <br />CON'fRACTOR, NO. <br />~ILLER, JERRY <br />435 N, MACY <br />IN~CMINNVILLE, OR 97128 <br />PHONE: 472-7618 <br /> <br /> i 'T' EM <br />BUiLDiNG FEE <br />PLAN REVIEW <br />FLEEI' BURCHARGE -ZONE 4 <br />BUILDING STATE ~:gJROI-IARGE <br />ZONING SU RCTIA NC3E <br /> <br /> ARCHiTECT/ENGINEER, NO. <br /> <br />TOTAL ASSEF~SED <br />PREY i C~JS RECEI P'I'~ <br />'I'H~8 RECEIPT <br /> <br />QUAN¥ITY <br /> <br />$~o.oo <br />$6.50 <br />5.12 <br />0.50 <br />0.59 <br /> <br />$22_62 <br /> $0.00 <br />$22.62 <br /> <br />BALANCE DUE $0.00 <br /> <br /> PAYEE: NILLER, JERRY 28417 <br /> RECEiVEO BY: PR TYPE: CK CHECK ~: 3934 <br />* THiS is NOT A PERMIT, THiS APPLICATION MUST GO THROUGH A RE¥IEN PR%,'CE~ WHERE THE <br />FOLLOWING MUST BE CF~IPLE'f'ED. IT iS THE RE~PONSiBILITY OF 'THE APPLICANT 7'0 AZiSURE I'HAI' <br />ALL NEC~RY INFOR~IA'rIoN HAS BEE~I PROVIDED, <br /> <br /> <br />