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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 /> Other <br /> <br />SlruS*~0492 OL~f~D RD ~ NE <br /> <br />FAMILY D~ELLiNG5 <br /> <br />PHONE: 6'/8-1157 <br /> <br />SIGNATURE OP APPLICANT <br /> DATE <br /> <br /> CONSTRUCTION TYPE 5.~N <br /> <br />CONTRACT CITY UGB <br />MARION COUN f Y NO <br /> <br />SiTE NUMBER: <br /> VALUAfION: <br /> <br />LOT BLOCK SECTION <br />WIDTIf DEPTH AREA <br /> <br />1 g 4~ <br /> <br />5. UNITS ,~.C IRREG LOT <br /> <br />1W <br /> <br /> NO <br /> <br />CATEGORY RESI D~NI IAL <br /> <br />OCCUPANCY <br /> R-3 <br /> <br />OCCUPANT LOAD <br /> <br />NO O~ <br /> <br />13256 <br /> <br />5 <br /> <br />CORNEF~O <br /> <br />~YP~: BU 1 [.D I, NG <br /> <br />~ON f RAOfOR, NO. <br />(~ J ANt:I_I_A, DELVER <br /> <br />FERMI1 (DR APPLICAfIDN NO: <br /> <br /> 90368~5 <br />ARCHITECT/ENGINeER, NO. <br /> <br />PHONE: f~'Z 8-1157 PlflON E: <br /> <br />UUILDING FEE <br />ADDiTiONAl, BUILDING FEE5 <br />~ONtNG ~URCHAR~E <br />AD0Jf]ONAL L.-AJRCHARGE5 <br /> <br />PAYEE; GIANELLA, <br />RECEIVED ~Y; CL <br /> <br />D~LV~R <br /> <br />TOiAL A~ED FEES <br />PRE¥iOUS RECE~PfS <br />]H~S RECEIPl <br /> <br />BALANCE DUE <br /> <br />~UAN T i IY <br /> <br />AMOUN ] <br /> $10_00 <br /> <br /> 0.25 <br /> <br /> $15_ ~5 <br /> $0. O0 <br /> <br /> $0_ O0 <br /> <br /> fYPE~ OK CHECK ~: 1045 <br /> <br />:* [HiU I~ NOT A P~RMi[. [HiS APPLiSATiON MUSf G~ r'HROOGH A REVIEW PRY-)CE~ WH~RE THE <br />!;OLLOWlNG MUST BE COMPLETED. Il ~8 I'HE RESPONSiBiLIfY OF' '1HE APPLiCAN'f fO ASSURE THAf <br />ALL NECE~ARY iNFO~AflON HAS BEEN PROVIDED. ~ <br /> <br /> ClfY JLIRISDICfiON; <br /> <br /> 5EPflC: BY DAf~; <br /> <br /> RENARKS: ~R~'RE5 <br /> ~O~AL ~ PT: 0 5fORiES: 2 PLAN.ACJiON: <br /> <br />OFFICE COPY <br /> <br /> <br />