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MARION COUNTY BUILDING INSPECTION <br />SENATORBLDG 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 />[ sm performin¢l work or~ a property ~ own or o¢oupy <br />larnaregister~dbuilderOFf~ )theauthor~zedrepresentative <br />of a registered builder <br />The work will be performed by a registered builder <br />Other. <br /> <br />r.4cBLJ$.l N E, <br /> <br />225 IU~T~LE 5¥ <br />ROil OR 9?342 <br /> <br />USE OF BUIL01NG <br />MAR. lNG <br /> <br />SINGLE, FAC4iLY ~ELLiNGS <br /> <br />SIGNATURE OF ARPLICANT <br /> DATE <br /> <br />TAX LOT CATEGORY <br /> 90222-3($0 RES I DENI IAL <br />CONSTRUCTION TYPE OCCURANCY <br /> <br /> 5-N R-3 <br />CONTRACT CITY UGB OCCUPANT LOA0 <br /> <br />O~f ROi'T' NO <br /> <br />HAMI~NO <br /> <br /> 2170 SIN 192ND <br /> ALOHA OR 9?006 <br /> PHONE: 649-2135 Sire NUMBER: 92-00939 <br /> VALUA F i~: $0.00 <br /> <br /> Z8 13 01 10 BE ~3 <br />WIDTH D~PTH A~EA UNITS IRREG LOT CORNER <br /> 75 80 8000. SF NO NO <br /> <br />BUILDING <br /> <br />CON T RACIOR, NO. <br />MCBLAiNE, R,J, <br />2170 SW 192ND <br />ALOHA OR 9?006 <br />PHONE: 649-2135 <br /> <br />PERMIT OR APPbiCA[ION NO: 38544 <br /> ARCHITECT/ENGINEER, NO. <br /> <br /> iTEM <br />ABDiIlONAL BUiLDiNG FEES <br />BUILDING STARE SURCHARGE <br /> <br />PHONE: <br /> <br />TOTAL A~ESB~D FEE5 <br />PRE¥tOUS RECEIPT'S <br /> <br />OUANT'ifY AMOUNT <br /> $0.50 <br /> <br />$10.50 <br /> <br /> $0.00 <br /> <br />BALANCE OU~ $0_00 <br /> <br />PAYEE: <br />RECEiVeD BY: PB IYPE: CHECK ~: 0 <br /> <br />~ ]HiS Ib A VALID P~RMIT * THIS PER~ll EXPiRE~ 189 DAYS FROM ils i~E DALE. iF <br />CONStRUCTiON C.E..ASES FOR A PERIOD OF 180 DAYS. OR IF CONSFRUCI~ON PAIL8 fO MEET ALI. <br />REQUiReMENTS OF STALE LA~'~ AND MARION COUNTY BUiLDiNG AND ZONING ORDINANCES, THiS PERMII <br />SHALL BECOME NULL AND VOID. <br /> <br />~B~BACKB: FR 20 L~ 5 ~ 5 RR 5 ~P ...... <br />REMARKS: DECcF. JLIrlON O~ A ~fRUCFORE <br /> DISCONNECI ALL UIILIf'i~' <br /> rUrAL ~ Pr: 0 <br /> <br />$'fORIES: <br /> <br />DONALD g. WOOOLEY, MARION CXAJNIY BUILDING OFHICiAL / 8Y <br /> <br /> DAP OFF AND <br />PLAN. ACfi7, <br /> <br /> OFFICE COPY <br />FORM # MC 15-56 REV ~ <br /> <br /> <br />