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M,~RION COUNTY BUILDING INSPECTION <br />SENATOR BLDG NO 225 <br />220 H~GH STREET NE <br /> SALEM. OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4::30 <br />';'4 HOUR CODE-A-PHONE:: 588-7904 <br /> <br />SIGNATURE OF APPLICANT <br /> <br /> MARION COUNi Y <br /> <br />NO <br /> <br /> RESi DbN f iA <br /> <br />OCCUPANT LOAD <br /> <br />NO 0P 8£(m00MS <br /> <br />MAILING <br /> <br />SINGLE PAJ~IILY OWELLtNG~ <br /> <br />PARK <br /> <br />PHONE: 364-998t <br /> 11 <br /> <br /> SITE NUMBER: 12527 <br /> VALUATION: $8,000.00 <br /> <br /> IRRE~ LOT CORNER <br />AC NO NO <br /> <br />IYPE: BUiLDiNG <br /> <br />CONfRAC¥0R, NO. <br />ELK~N~, RAY <br /> <br />PERMIr OR APPL~CAF[ON NO: <br /> <br /> 9080995 <br />ARCHITECT/ENGiNEER, NO. <br /> <br />PHONE: ~64-9967 <br /> <br /> ifE~ <br />BUILDING FEE <br />PLAN REVIE~ <br />BUigOING STALE SURCHARGE <br />ZONING 5Uk%,~ARGE <br /> <br />TOIAL ASSESSED F'EE~ <br />PREVIOUS RECEIPTS <br />THiS RECEJ. P~ <br /> <br /> BALANCE f3.JE <br /> PA%g~: ELKINS, ~AY ~ <br />..... ................. ............... rY, = <br /> <br />QUANIITY <br /> <br />~N'I <br /> $68.50 <br /> $44.53 <br /> $3.43 <br /> $3_~3 <br /> <br />$I19.89 <br /> $o_oo <br />$719.89 <br /> <br />$0.00 <br /> <br />32738 <br />2636 <br /> <br />.¢ ~FII~ i;5 NOr A PERMIt. tHIS APPLiG'ATiCE/ [v~JST GO ~H~G~ A REVIEW P~E~ ~ERP. [HE <br />POLLOWlNG ~SI BE ~PLEIED. I1 IS 'IHE RE~SISiLI1Y OF 1HE APPLiCAN[ '~O A~RE THAi <br />ALL, NEC~ARY iNFO~Ti~ H~ 8~ P~V~DEO. <br /> <br />Ci]Y JURiSDICIlCf4: BY DATE <br /> <br />~-O.M ~ MC ~S,S~ REV 4/0o OFFICE COPY <br /> <br /> <br />