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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:: $88-7904 <br /> <br />SIGNATURE OF APPLICANT <br /> DATE <br /> <br />JOE <br /> <br />DEN ~ 1 AL <br /> <br /> 11697 FALCON CQORf <br />~tJRORA <br /> <br />OR 973002 <br /> <br />NE <br /> <br />CONTRACT CITY i! UGS <br /> <br />OCCUPANT <br /> <br /> NO <br /> <br />~UFAO[URCO 5TRtJC{URE <br /> <br />SUBDIVISION <br /> <br />3 <br /> <br />PHONE: SiTE NUMBER~' <br /> .VALUA1 iON *.,, ZONE <br /> <br />14128 <br /> <br />~? 125 SF Y~: NO <br /> <br />1YPE: fCtANUFACTURED SfRUC[URE PERMIT OR APPLIf.~'fiON NO: 35193 <br /> <br />CON YRACIOR, NO_ 61964 <br />HARRi~ HOME5 <br /> <br />MiLWAUKiE, ORE g7222 <br />PHONE: 654-02~5 <br /> <br />TOIAL ~ED FEE~ <br />PRE¥iOUS RECEIPTS <br />fHiS RECEIPt <br /> <br />~ANTiIY A~'FOLINI <br /> $182.00 <br /> $2~.00 <br /> <br /> Sqb.O0 <br /> <br />$226.'10 <br />$226.]0 <br /> $0.00 <br /> <br />BALANCg DUE <br /> <br />PAYEE: RECEIPT <br /> <br /> RECEIVED BY: b~ TYPE: CHECK ~: 5 <br /> <br /> ~ THiS IS A VALID P[5~IIT ~ THIS PER~iT FEE COVEF~ ONE iNSP~Ti~ ~D <br /> ~INSP~T[~. ALE BLCKING, STAIR INSTAL~TI~, P~JNG, ~I~L, ~D EL~TRI~L <br /> ~NECTI~ ARE R~lRED TO BE ~LETED U~ RE~ POR THE ¢l~T IN~P~TI~. iP ~Y <br /> OF THE iT~ ARE IN~PLETE, ~ ADDITI~AL [N8~T1~ FEE HILL 8E RE~/REB. PE~IT <br /> VALID ~R SIX~THS~LY. ~ED FOR 6 ~TH8 U~ ~RITT~ R~T <br />PRIOR TO THE ~PI~TI~ ~TE OE THE ~[T. IF ~T~CTI~ FAI~ TO ~T ALL <br />~IR~TS OF STATE ~ ~D ~RI~ ~NTY BU/LDING~D Z~IN60RDIN~C~, THIS <br /> <br /> 5bfBACKS; FR 10 LS 5 R5 15 RR 10 5P ~.~ <br /> N~RK5: ~FG H~ R~3510 <br /> <br /> PL~NING ACTION: <br /> ~JNALD E. NOODLEY, NARiON C~N'fY BUILDING OFFICIAL / MY <br /> <br />~O~M ~ ~c ,~-~ R~v 4~o OFFICE COPY <br /> <br /> <br />