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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 own or occupy <br />I am a registered builder OR( Ithe authorized representative <br /> <br />Other. <br /> <br />have read and agree to ~he terms stated on the reverse side of <br />thru document <br /> <br />SIGNATURE OF APPLICANT <br /> PATE <br /> <br />°w~&~-E: 10/25/90 TI~IE: 15:48:16 <br />SITUS ^DDRE4~LLIOT, HARDY <br /> <br />285 3RD Sl -- <br /> <br />MAILING ADCRESS <br /> SINGLE FA~IlLY BNELLiNG~ <br /> <br /> 1100 ~MSffiEKEIA NIE ~102 <br /> SALEM 97301 <br /> PHONE: 581-1020 <br />LOT BLOCK <br /> <br />SECTION <br /> <br />WIDTH 4 <br /> <br /> OEPTH 4 AREA 25 <br />50 ~n~ c.nn <br /> <br />TOWNSHIP <br /> <br />UNITS <br /> <br />TAX LOT <br /> <br />CONSTRUCTION 1YPE 90080--190 <br /> <br /> CONTRACT CITY <br /> <br />AUfC~Vl LLE NO <br />5UBDI,¢ISION <br /> <br />CATEGORY <br /> <br />OCCUPANCY RESI DEN i iAL <br /> <br />OCCUPANT L~q,~ <br /> <br /> MERRi P1 ELD <br /> <br /> ~iIE NU~ER: 11540 <br /> RA~¢:~.LUAIlGI'4: ZONE $1,865.3~Ap <br /> <br />8S IRREG LOT ~ CORNEP ~ <br /> <br />lYPE: BUILDING PERMIF OR APPLICA1"ION NO: <br /> <br />IXINIRACI'OR, NO. 64315 <br />INI ~R1 FY CONSIrRUCl iON <br />55?5 RAMP ,SI' NE <br />SALEM 97305 <br />PHONE.: 390-4826 <br /> <br /> I rEM <br />BUiLDiNG FEE <br />PLAN Rm~w I F_..W <br />FLEE1 ~RCHARGE -ZONE 3 <br />BUILDING 'SFATE E~JR~CHARYGE <br /> <br /> 28221 <br />ARCHiTECT/ENGINEER, NO. <br /> <br />I'O'TAL AE~E&~ED FEES <br />PREVI CU'S R~EI P'F'S <br />1Hi,S RECEIPT <br /> <br />QMAN f ll'Y <br /> <br />~31.00 <br />20+15 <br /> $3.84 <br /> $~ .55 <br /> <br />$56.54 <br />$58.54 <br /> $o.oo <br /> <br />BALANCE I,,lJE $0, O0 <br /> <br />PAYEE: <br />RECEIVED BY: PR TYPE: CHECK ~ 0 <br /> <br />* THI,S IS A VALID PERMI1 * THI~ PERMII' EXPiR~ 180 DAYS FROM I[,S i~E ~IE. IF <br />~Sr'~O'f'I~ C~ FOR A PERIOD OF 180 DA~, OR IF ~s"r~crI~ FAI~ 'f'O MEET AL.L <br />RE~IREMENF5 OF $1A~E ~ ~D ~RI~ ~NFY BUILDING ~D Z~iNG ORDiN~C~, 1H15 PEril <br />~ALL B~E NULL AND VOID. <br /> <br />'SETBACKS: FR L$ <br />RE~ARF~: RE-RC¢JF <br /> <br />~ RR SP <br /> <br />HEIGHI: l'Ol'AL ~ FT: 0 STORIE'S; <br /> <br />CONALO E. ~LEY, Ivt~RiON COUNIY BUILDING OPFICiAL / BY <br /> <br />PLAN i~TiON.+ <br /> <br /> OFFICE COPY <br />FORM # MC 15-56 REV 4/~o <br /> <br /> <br />