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JvlARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALI::M, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 558-7904 <br /> <br />Other_ <br /> <br />~ bare read and agree to ¢~e terms stated on the reverse side of <br /> <br />DATE; <br /> <br />ow~'I'g: 08/31/90 <br /> MILLER, JERRY - RENTAL HOUSE <br />SITUS ADDRESS <br /> <br /> 5555 HO~EL~.PRAiRiE RO SE <br /> AUIVISVILLE OR g?325 <br /> <br />USE OF BUILOING: <br /> <br /> 5--N <br />"~NTRACT CITY; UGH: <br /> <br />IV!AR iON CXAJN :I:-Y- ..........NO <br /> <br />RES 1 DEN I J. AL <br /> <br />, NO OF BEDR00M$ <br /> <br />MAILING ADORESS: SINGLE FAMILY t~ELLIN~ <br /> <br /> 435 <br /> MCMiNNV~LLE, OR 9? <br /> PHON6:472-7818 <br /> <br /> 78 112 8736. <br /> <br />SUBDIVISION <br /> <br />TOWNSHIP <br /> <br /> 8S <br />UNITS: <br /> <br />SITE NUIVEtER: 11092 <br />VALUATION: $12,600.00 <br /> <br /> 2N.: EFU~ <br /> NO ' NO <br /> <br />2 <br /> <br />TYPE: BUILDING PER~IT OR APPLICATION NO= 9026901 <br /> <br />CXDN'fRAC'TOR, NO. 54803 <br />JERRY MILLER <br />435 N NACY ST <br />IVICMINNVILLE, OR 97128 <br />PHONE: 472-7518 <br /> <br />A~ i'?ECI'/E~GINEER, NO. <br />PHC~'NE: <br /> <br /> iTEM <br />BUILDING FEE <br />PLAN REVIEW <br />FLEET ~URCHAR~E -ZCC4E 9 <br />BUILDING STAT/ SURCHAC'~E <br />ZONING SURr,,,1,4ARGE <br /> <br />OUAN'rITY <br /> <br />I'OTALAE~E&SED FEES <br />PRE~IE~JS RECEIPT5 <br />THiS RECEIPT <br /> <br />BALANCE DUE <br /> <br />~98_50 <br /> ¢3.84 <br /> 4,93 <br /> $4.93 <br /> <br />$175,23 <br /> SO.g0 <br />$176.23 <br /> <br />$0.00 <br /> <br /> PAYEE: JERRY MILLER '~,.~ 28456 <br /> RECEIVED BY: CL ................................. ~ ............ TYPE: CK C~ECK ~: 393'1 <br /> <br />* THIS IS NOT A PERMIT. THIS APPLICATION MUST GO THRr.~GH A REVIE~ PROCESS INHERE THE <br />FOLLONiNG MUST BE O%.WIPLE'fEB. ~T IS THE RP. DTSPONSiBiLiTY OF THE APPLICANT TO A~URE THAT <br />ALL NF.;"C~ARY iNFORMATIONHAS SEEN PROVIDED. <br /> <br />PLAN Rg¥IEN: BY ...................................... <br /> <br />DATE ............................................. <br /> <br />CiTY JURISDICTION: BY ............................. DATE ............................ <br /> <br />SEP'IIC: BY ................................................. BATE .......................................... <br /> <br />ZONING: BY DATE S[I'BACF~': FR.~ .... <br />REMARKS: AOD? RES ................. 9 <br /> <br />HEIGHT: 12 'T'OTAL ~ FTt 420 STQRIE%: <br /> <br />"1 PLAN.ACTiON; <br /> <br /> <br />