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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 />performing work ofq a property I own or occupy. <br /> <br />SIGNATURE OF APPLICANT: <br /> DATE: <br /> <br /> BATE: 12/'t?j91 ;'.£ME: 12t27:33 <br /> OWNER: <br /> B~OWN , VI( <br />S[TUSAO0~ESS: <br /> <br /> 345 EVE~REEN DR <br />AUMSV;LLE <br /> <br />OR 9?325 <br /> <br /> TAX LOT: <br /> <br /> 5770f5--000 <br /> <br /> 5-N <br /> <br />AUM~,V T LLE NO <br /> <br />CATEGORY: <br /> RESIDENT <br />OCCUPANCYZ <br /> <br />OCCUPANT I CAD: <br /> <br />REST ~JEN f' i AL A~'~SORY STRUE' ;URE,~: suBmwsl0~: <br /> <br />EvERr~REEN MOSfLE PARK <br /> <br /> PHON E;: <br /> <br />LOT: BLOCK: SECTION: TOWNSH <br />25 <br /> <br />SHE Nur4BER: 14708 <br />VALUAT TON; $3,120.00 <br />RANGF: ZONE: MAP: <br /> <br />IRREG. LOT: 0ORNER: <br /> YES NO <br /> <br />f'YPE: BL..[L_DLNG PEf~l'41'f' OR APPLICATION NO: <br /> <br />CON'~ RAC ~OR, NO. 38238 <br />D,~D'ie'[ L Car"v'er' <br />'1'f3'73 IvB]"l Cheek Rd <br />Aumsv ~ "l "le, 97325-0000 <br />PH~E: <br /> <br /> I'f'EM <br />BUILDING FEE <br />PLAN RE¥1EW <br />BUiLDiNG STATE SURCHARGE <br /> <br /> 9027426 <br />ARCHiIEC'T'/ENGiNEER, NO. <br /> <br />OUANf'ITY <br /> <br />AMOUNT <br /> ~44.50 <br /> 28,93 <br /> $2.23 <br /> <br /> TOTAL A~E~SED FEES <br /> RREViOUS RECEIPTS $0.00 <br /> 'f'H~S RECEIPT <br /> <br /> BALANCE DUE $0,00 <br /> PAYEE: E~nffe"l L C~Pven /~ 39391 <br /> RECEIVED BY: P8 ~ TYPE: iN CHECK ~: 0 <br /> <br /> * ~'HIS ~ NOT A PERf41'f. 'f'HiS APPLiCATiON NU~T GO THROUGH A RE¥~E~ PRC,X~S WHERE <br />FOLLO~TNG tvlUSf' BE CONPLE'I'EO. 1'r iS THE RESPONSJBIL~'f'Y OF THE APPLICANT TO A~rSURE THAT <br />ALL NECE~ARY ~NFORlVlA'f'1ON HAS BEEN PROVIDED+ <br /> <br />PLAN REViEW: <br /> <br />3EP'I'iC; BY DATE <br /> <br />ZONTNG: BY 0AI'E ................................... SETBACKS; <br />REI'4ARI~: CARPOR~ ........... <br /> <br />HE~GH']': !t TOI'AL SO F'I'; 312 <br /> <br />CITY JURTSDIC'f'iON; BY DATE <br /> <br />FR 10 LS 10 ~ 10 RR 10 SP <br /> <br />STORIES: I PLAN.ACTTON; <br /> <br /> OFFICE COPY <br />~RM # MC 15-56 f~EV. '~tgo <br /> <br /> <br />