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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 />lam performmclworkona propery owno occupy <br />I am a registered b~ Ilde OR ~ he au ho zed rep osen a e SIGNATUBE OF APPLICANT <br />of a registered bdilder <br />The work w~l be performed by a registered builder <br />Other,., <br />I have read and agree to the terms statod on the reverse side of DATE <br />tb~s document <br /> <br />OWNf~ T E: 11/15/91 fiRE; 8:3?':57 <br /> TAX LOT <br /> <br /> COX, DARVIN <br />SITUS ADDRESS CONSTRUCTION TYPE <br /> <br /> F40 MAIN ST <br />~UMSViLLE <br /> <br />OR <br /> <br />CONTRA~T CiTY <br />AUtV~V I LLE <br /> <br />5-N <br /> LJGO <br /> <br />MAILING ADDRESS SINGLE FAMILY DWELLINGS <br /> <br />CAI'EGO~Y <br /> <br />OCCUPANCY <br /> <br />OCCUPANT LOAD <br /> <br /> PHONE; <br /> <br />LOT <br /> <br />SECTION <br /> <br />AREA <br /> <br />TOWNSHIP <br /> <br /> Sl]E NUMBER: <br /> VALUAtiON; <br />RANGE <br /> <br />}3815 <br /> <br /> CORNER <br /> <br />NO NO <br /> <br /> fYPE: BUIL01NG <br /> <br />C(2NfRAC~OR, NO. <br />COX, DARViN <br /> <br />PERI4~'f OR APPLiCAT'iON NO: <br /> <br /> 36382 <br /> <br />RCHi TECI/EhGINEER, NO. <br /> <br />PHDN~: 749-22:J'! PHONE; <br /> <br />BUiLDiNG FEE <br />PLAN REVIEW <br />BUILDING SYATE SURCHARGE <br /> <br />PAYEE; <br />RECEIVED BY: P8 <br /> <br />FOrAL ~E~ED FEES <br />PREVIOUS RECEiP'IS <br />'rRI~ RECEIPT <br /> <br />AMOUNT <br /> <br /> $13.~3 <br /> $~.o3 <br /> <br />¢34.85 <br /> 34.86 <br /> <br />BALANCE DUE $<J , (JO <br /> <br /> ............................................. YYPE: CHECK ~: 0 <br />* fHiS tS A VALID PER~i] * IHiS PERMi~ EXPIRES 180 DAYS FROM i~ ISSUE DAI~. 1P <br />CONS[RUCflON CP_A,.SES PeR A PERIOD OF 180 DAYS, OR IF CONSIRUCTION FAIL~ fO MEEf ALL <br />REQUIREMENTS DP SiA'I6 LAWS AND MARION COUN'IY BUILDING AND ZONING ORDINANCES, ¥Hi5 PERMIT <br />SHALL BECOM~ NULL AND VOID. <br /> <br />SETBACKS: PR LS RS RR SP <br />R,.................~4RKS: ......................... ~ <br /> <br />BEIGH]: 20 fOIAL SQ El: 0 SIORiE~:,: <br />DONALD E- WOODLEY, MARION COUNIY BUILDING OFFiCiAl_ / BY <br /> <br />PLAN.AC¥1ON: <br /> Of,_. <br /> <br />OFFICE COPY <br /> <br /> <br />