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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 have read and aflree to the terms statod On the reverse side <br /> <br />CARE: 04/09/91 'liME: 11:58:59 <br /> <br /> HOLOUBEK, ROSERI <br /> <br />SIGNATURE OF APPLICANT <br /> 0ATE <br /> <br />~AX LOT <br /> 90221-150 <br />CONS'f RUCTION TYPE <br /> <br />CATEGORY <br /> <br />OCCUPANC~ <br /> <br />Rb~Si DEN ] IAL <br /> <br /> 200 SANTIAR AVg <br />DEiROII OR 9'1342 <br /> <br /> CONTRACT CiTY <br /> <br />,Oa JR Oi I <br /> <br />UGB <br /> <br />NO <br /> <br />OCCUPANT LOAD <br /> <br />2150:54, IH AVE NB <br />PHONE: 303-5578 <br /> <br />SUBDIVISION <br /> <br /> HAIVlMON D <br /> <br />I©T 8LOCK SECTION TOWNSHIP <br /> <br /> ]1 9 2 10 <br />WIDTH DEPTH AREA UNITS <br /> 50 150 7500 - SF <br /> <br />511E NUIVlE~EN: 12674 <br />VALUA T I ON: <br />RANGE ZONE <br /> <br />IR~ LO'~ I C~RNER <br /> NO : NO <br /> <br />MAP <br /> <br />FYP~,: PLUr~diNG PEF~IlF OR APPLiCATiON NO: 31400 <br /> <br />CONTRAOIOR, NO. <br />HoLOUB~K,ROBERf <br />2150 341H AVE NE <br />SALEM, OR 9'1303 <br />PHONE= 3~3-55'18 <br /> <br />WAIER LIN~, 15T /00 FEET <br />~BILE HOI~E SEWER AND WAIER CONNECT'iON <br />PLUMBING SIAIE SURCHARGE <br /> <br />ICl'AL ~ED FEE5 <br />pREWiOLIS RECEiPtS <br />'THIS RECEIPT' <br /> <br />QUANIIfY AMOUNI <br />~ $20.00 <br />1 $25.00 <br /> $2.25 <br /> <br />$47_25 <br /> <br /> $0.00 <br /> <br />BALANCE DUE $0- O0 <br /> <br />INVOICE NO: <br />CHECK <br /> <br /> PAYF..E: <br /> RECEIVED ~Y: PR Typr-: <br /> <br />* THiS IS A VALID PERI~IT * THIS ~lT ~IR~ 180 ~ ~ iTS i~E ~TE. <br />~ST~CTI~ C~ ~R A ~RiO00E 180 ~, OR IF ~T~CTI~ ~Ai~ TO MEET ALL <br />R~iR~TS OF STATE ~ ~D ~Ri~ ~NTY BUILDING ~D Z~iNG ORDiN~C~, THIS <br />~ALL B~E NULL ~D VOID. <br /> <br />REMARKS: W/S CONN, WL <br /> <br />bC}NALD E. WOODLEY, MARION COUNIY BUILDING OFFiCiAL / BY <br /> <br />FORM # MC 15-56 REV 4/,~) OFFICE COPY <br /> <br /> <br />