Laserfiche WebLink
MARION COUNTY BUILDING INSPECTION <br />SENATOR BLOG. NO. 225 <br />220 HIGH STREET RE <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 />}ama registered builder OR{ ) the authorized representative <br />of 8 registered builder. <br />The work will be performed by a registered builder. <br />Other. <br /> <br />have read and agree to the terms stated on the reverse side of <br /> <br />SIGNATURE OF APPLICANT: <br /> DATE: <br /> <br />OWNER: TAX LOTZ <br /> DATE: 08/01'/90 <br />SfTUS ADORES~RO~' PAULINE <br /> <br />CATEGORY: <br /> <br />OCCUPANCY: <br /> <br />RESiDENTiAL <br /> <br /> CONTRACT OITY: <br /> <br /> 140 L.AKECR~'f' DR -- <br />u SEg~T~i~J~i~G. OR 9'/'34,2 <br />DETROIT <br /> <br />MA~L~NG ADDRESS' SU BDIV~SION' <br />RESJ~BF_.N'f'.I, AL AOC~RY 8'rRuc'ruRE,~ <br /> <br />OCCURANT t_ {~¢~.? L~ <br /> <br />NO <br /> <br /> PAT 1ON t <br /> 479 ~ CRIOER <br /> DALLAS, OR 97338 <br /> PHONE; <br /> NU~ER; <br /> 10879 <br />LOT,. '~LUA'T']~: ,ZONE:~ U~5¢087.0 <br /> <br />4 1 2 10 5~ <br /> <br />TYPE: 8UiL01NG PER:I',IlT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. 43481 <br />BAILEY, DAVID R <br />235 OAKViLLA RD <br />DALLAS, OR 9~338 <br />PHONE: 623-5241 <br /> <br />BUILDING FEE <br /> <br />FLEET SURCHARGE <br />BUiLDiNG STATE 6~,JR(2HAA'~E <br /> <br /> 902824? <br />ARCHi'T'ECT/ENG~NE~R, NO. <br /> <br />PHONE: <br /> <br />TOTAL ASS~ED FEES <br />'I'HI~ RECEIPT <br /> <br />OU~I'iTY <br /> <br />AIvIOUNT <br /> 56_50 <br /> 36.73 <br /> <br /> $2.83 <br /> <br />$105.92 <br /> $o.oo <br />$105.02 <br /> <br />BALANCE DUE $0.00 <br /> <br /> PAYEE: BAiL~Y, .OAVID R 2?803 <br /> R~CEiVEO BY: e'12 ..................................................................................... 'FYPE~ IN CHECK ~: 0 <br /> <br />~ 'f'HJ~ i~ NOT A PER~l'r. 'f'HJ$ A~PLICATiON IviUST60 THR~UGHA RE¥~E~ PROCE~ NHERE THE <br />F'OLL~iNG ~S'f' BE ~PLETED. ~l' $8 THE RES~8iBILII'Y OF THE APPLICANT TO ASSURE f'HAT <br />ALL N~C~A~ INFO~'f'I~ H~ BE~ P~lOED. <br /> <br />SEPIiC: BY ........................................... E)A'FE ............................................. <br /> <br />ZONING: BY DATE <br />RPJ~LARKS; DECR ................................................... <br /> <br />HEiGH'1: 0 TOTAL ~ FT': <br /> <br />CITY JURISDiCI'iON; BY DATE <br /> <br />SETBACKS; FR 20 LS 5 RS 5 RR 5 SP <br /> <br />0 STORIE,..'S: 0 PLAN.AC'T'iON; <br /> <br />OFFICE COPY <br /> <br /> <br />