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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 />f~ArE~ 04/08/91 r~,ME: 12:08:40 <br /> <br /> HOLE)UBEK, ROBER 1 <br /> <br /> 200 SANfIAM AVE -- <br />OBi ROi1 OR 9?342 <br /> <br />USE OF BUILDING <br /> <br />SIGNATURE OF APPI_ICAN) <br /> DATE <br /> <br /> TAX LOT <br /> <br /> CON S'f'RUCTIO N TYPE <br /> CONTRACT CITY <br /> <br />90221-150 <br /> <br />CATEGORY <br /> <br />OCCUPANCY <br /> <br />OCCUPANT LOAD <br /> <br />2150 34f'H AVE NE <br />PHONE: 363-5578 <br /> <br />SUBDIvISiON <br /> <br />tOT BLOCK SECTION TOWNSHIP <br />11 9 2 10 <br /> <br /> SIiE NUMBER: 12674. <br /> VALUA f' I ON: <br /> <br />RANGE ZONE <br /> <br /> 5E <br />IRREG LOT NO ~CORNERoN <br /> <br />DEN i i AL <br /> <br />NO 0f 8EDR00MS <br /> <br />MAP <br /> <br />TYPE: PLUCViB i NG <br /> <br />CON iRACIOR, NO. <br />HOLC~JBEK,ROsERr <br />2150 ~41'H AVE NE <br />SALEM, OR 9?303 <br />PHONE: 363-55?8 <br /> <br />PE~i'T OR APPLICA'fION NO: 9031400 <br /> <br /> IrEN <br />NA'IER LINES, 1S'f 100 FEET <br />F!Of~ILE HOME SEWbR AND HALER CONNECTION <br />PLUMBIN6 sTArE SURCHARGE <br /> <br />PAYEE; HOLOUBEK,ROBERf <br /> <br />IO1AL ~E~ED FEES <br />PRE¥iCtJS RECEIPTS <br />1HIS RECCiP'T <br /> <br />QUANT'IIY ANOUNT <br /> <br /> 1 . <br /> $2.25 <br /> <br />$47.25 <br /> $o.oo <br />$47.25 <br /> <br />BALANCE 0UE $0.00 <br /> <br />INVOICE NO: 33161 <br /> <br /> RECEIVED BY: PR 'TYPE: IN CHECK ~: 0 <br /> <br />* THiS 18 NOT A PERMIT. THIS APPLICATION MUST GO THROU(~t A REVIEW PROCESS ~'-IERE THE <br />FOLLO~1N~ r4UST BE CO~IPLETED+ [T 15 THE RESPON~IB[LZTY OF THE APPLICANT TO ~RE THAT <br />ALL N~C~RY INFORMATZON HA~ BEEN PROVIOED+ <br /> <br />PLAN RE¥iEN: BY <br /> <br />REMARKS: N/S CONN, NL <br /> <br />DArE <br /> <br />CIFY JURISDICTION; BY ........... 0A'fb <br /> <br />FORM # MC 15-56 HEV 4/90 OFFICE COPY <br /> <br /> <br />