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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG. NO. 225 <br /> 220 HIGH STREET CIE <br /> SALEM, OlZfEG©N 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:80 <br />24 HOUR CODE-A-PHONE: 588~7904 <br /> <br />The work will be Bedormed by a registered builder, <br /> <br />SIGNATURE OF APPLICANT: <br /> DATE: <br /> <br />ow~TE: 08/2't/9o <br /> <br /> '1 ROM, PAULJ N~ <br />SITUS ADDRESB: <br /> <br />TAX LOT: <br /> <br />90250-030 <br /> <br />CATEGORY: <br /> <br />OCCUPANCY: <br /> <br />R~5IOENT.[A,C <br /> <br /> 140 LAKEiJRES'f' DR <br />DE','TR(JI T' OR 9?342 <br />USE OF BUILDING: <br /> <br />: CONTRACT 01~¥: <br /> <br />OE'f'RO! F <br /> <br />NO <br /> <br />OOOU PAN'f L~J~O:' <br /> <br />MAll. lNG AODRESS: RESZBEN'f:iAF A~E~0~Y S'f'fQ-IgO'f'Ll~E~ SUa~iW~i0N; <br /> <br />4'79 SN CRIOER <br />OALLA~, OR <br />PHONE:: 623-4279 <br /> <br />LOT: BLOCK: SECTION: <br /> <br />PAT'TON i <br /> <br /> SiTE NU~ER: <br /> VALUAT l ON: <br />: TOWNSHIP RANGE: ZONE: <br /> <br />10879 <br />$5,087.00 <br /> MAP: <br /> <br />4, <br /> <br />'~ !AREAz 2 iUNi~B: t0 IRREG. LOT: SE' CORNER: <br /> 1.6;~ ! 14670~ SF' NO NO <br /> <br />TYPE: ~UiLDiNG PERIVII! OR APPLICA'T'ION NO: <br /> <br />CONT'RACTOR, NO. 43481 <br />BAILEY, DAVID R <br />235 OAKVILLA RD <br />DALgA~. OR 9?338 <br />PHONE; 623-5241 <br /> <br /> ITEM <br />BLJILDiNG F~E <br />PLAN <br />FLEEI ~R"CHARGE ~ZONE '? <br />BUILDING S'IAf'E ~¢.JRC~ARG~ <br /> <br /> 2624? <br />ARO~if'ECf/ENGiNEER, NO_ <br /> <br />QUAN'Y'I'TY <br /> <br />'TOTAL 4Z'"'"'"'"'""SSESSED FEES <br />PREWiOUS RECEIPTS <br />I'HiS RECEIPT <br /> <br />AMOUN/' <br /> <br /> 36. ?3 <br /> <br />$105.02 <br />$!05.02 <br /> <br />BALANCE DUE <br /> <br /> PAYEE'; <br /> ~,.,C,f'_i~!= 13Y: DM2 , TYPE: C.flECK ~: <br /> <br />· ¢ THfS rS A VALiO PERW~I'T ~ ']'H~8 PERH~'i' EXPIRES ]80 ~Y~ P'~ iTS ~UE DATE. <br />CONSf'RUC'fI~ (.,~, .c>~o FOR A PER~OD OF ~80 DAYS, OR tF C~S'f'~C'f'I~ P'AZLS TC) ~E~f ALL <br />~EOUZRE~ENTS OF' S~Af'g LA~ AND ~AR~ON COUNTY BU]LD[NG AND ZONING ORDI, IANCES,' ' ~ "'"'" f'H~S PERM.~r <br />SHALL 8ECC)~E NULL AND VOID, <br /> <br />SEIBACKS'_ FR 20 L2;5 5 RS 5 RR 5 <br />R EI~IAI,(K~ <br /> <br />kb:[Gf"t'f: TO'T'AL SO F'T': 0 S'FORIES: <br /> <br />CX)NALD E:.. WOODLEY, MARION COUN'T'Y BUILDING OFFiCiAL / ~Y <br /> <br />OFFICE COPY <br /> <br />FORM # MC 15-56 REV, 4190 <br /> <br /> <br />