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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 />Othor <br /> <br />I have read and agree to the terms 8rated on the reverse side of <br /> <br />~IGNATURE OF APPLICANT <br /> <br /> DALE; 04/09/91 riME: 11:59:08 <br />OWNER <br /> <br /> HOLOUB~K,R(,~ERI <br />sHus AOOAESS <br /> <br />90221-150 <br /> <br />CATEGORY <br /> <br />OCOUPANCY <br /> <br /> 200 SANFiAM AVE <br />Ob lk~l I OR 97342 <br /> <br /> CONTRACT CITY <br /> <br />DEl ROi 1 <br /> <br />NO <br /> <br />OCCUPANT LOAD <br /> <br />MAILING ADDRESS <br /> <br />2150 34tH AVE NE <br />PHONE: 363-5578 <br /> <br />HA~OND <br /> <br />11 9 2 10 <br /> 50 150 ?500 - SF <br /> <br />SITE NUMBER: 12674 <br />VALUA f I (DIN: <br />RANGE ZONE <br /> <br /> 5E <br />IRREG LOT CORNER <br /> NO . NO <br /> <br />RESiDENIlAL <br /> <br />MAp <br /> <br />IYPE: MECHANICAL PERMiI OR APPLICATION NO: <br /> <br />CON!~ACIOR, NO. 5Y704 <br /> <br />908 ~JEWAfER NN <br />SALE~, OR 97304 <br />I~ONE: 3'Z8-0182 <br /> <br /> iIF~ <br /> <br />MECHANICAL BASE FEE <br />ME~4ANICAL SfAf'E SURCHARG~ <br /> <br />PAYEE: <br />RECeiVeD BY; PR <br /> <br />$1399 <br /> <br />QUANIiIY A~OUNI <br /> $7.50 <br /> <br /> $0.88 <br /> <br />'fO'IAL ~ED FEES <br />PRE-t/JOgS RECEi P I'S <br />I'HiS RECEI Rl <br /> <br />18.38 <br />$o.oo <br /> <br />BALANCE DUE $0.00 <br /> <br /> INVOICE NO: <br />FYPE; CH6CK ~: 0 <br /> <br />* THiS IS A VALID PEi:~ilT * THiS PER~4IT EXPIRES 180 DAY~ FRO~i ITS ISSUE BATE. IF <br />CONSTRUCTION CEASES FOR A PERIOD OF 180 BAY$. OR iF CONSTRUCTiON FAILS TO r~EET ALL <br />REqUIRE~E$iTS OF STATE LAH8 AND I~IARION COUNTY BUILDING AND ZONING ORDINANCES, THiS PEI~IlT <br />SHALL BECI3~E NULL AND VOID. <br /> <br />R~fA&RK,5: I~FOODST OVE <br /> <br />~)ONALO g. ~DODLEY, MARION COUNIY BUILDING OFFICIAL / BY <br /> <br />~OR~l ~ ~c is-se REV 4mo OFFICE COPY <br /> <br /> <br />