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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br />,¥ <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> am pe O m f~g wo kon 8 property Iown or occupy. . <br />l am a registered builder OR ( }theauthorizedfepfesenta~ve <br />of a registered builder. <br />The WOt'k will be performed by a egistered builder, <br />Other <br /> <br /> BALLANCE <br />SITUS ABDRESS: <br /> <br />20142 OLMS'rEAO ROAO <br />AURORA OR <br />US6 OF BSiLd[NGi <br /> <br />MAILING ADORESS; <br /> <br />SJLNGLE P'AH£LY OWELEtNSS ; Sbamv~si6~'i ........ <br /> <br /> SAi~4E <br /> PI,ION <br /> <br />LOT: <br /> <br />6I'8-1151 ~ SiTE NU~ER: 92-01913 <br /> V'ALUA'.~'£ON; $.3.Z. 0,00-,00 <br /> Bi. CC K'. SEOTION: TOWNSHIP; ~ANGE; , ZONE: MAP: <br /> <br /> 'Lq ........ AC ...... BE). ....... BO <br /> <br />f'YPE: BUiLOiNG <br /> <br />CON'f'RAC'T'QR, NO. <br />I3ALLANCE, JEFF' <br /> <br />PERF},['¥' OR APPLICATION NO: 9040091 <br /> <br /> ARCHi'f'ECT/ENGiNEER, NC)- <br /> <br />PH ON E: t; Y' 9 - 1 ] 51 PHONE: <br /> <br />BUtgDING FEE <br />PLAN REVIEW <br />t~UILDiNG STATE SURCHARGE <br />ZONING SURCHARGE <br /> <br />'TOTAL A~ESSEO FEES <br />PREWiOUS RECEIPTS <br />THiS RECEIPT <br /> <br />QUAN'rl 1Y <br /> <br />AIvIOUN i <br /> 2x.s <br /> $79_ <br /> $6, '] 3 <br /> <br />$2'14_39 <br /> $0. O0 <br />$2q4,39 <br /> <br />BALANCE CUE $0, O0 <br /> <br /> PAYEE: 8ALLANCE, JEF.,~. ~z") 42'1~0 <br /> REOEZVEO BY: r~a ~,~ 'rxpr~: CK CHECK ~: 358 <br /> <br />· '['HI~ 1~ NOT A PERNLT. 'FHi~ APPL[CATi~ ~'F ~O THROU~ A REVIEW PROC~ WH~RE 7HE <br />FOLLOWING ~U~'1' B~ CO~PL~TED. iT i~ 'T'H~ REGPONSiBiLL'1'Y OF TH~ APPLiCAN'1' ]'O A~URg ']HA~' <br />ALL NECESSARY iNFORMATi~ H~ BE~ P~IOED. <br /> <br />CIf'Y JURiSDICTiON: <br /> <br />SEPT[C: BY DATE ENERGY PATH: 1 <br />ZONING: BY ~ ?ATE '..,~/'~¢/~ SE'f'SACKS: FR -- LS - ' RS <br /> t <br />RENARK~ AOO'~RG"'R'ZTCHEN KROO~ ...................................................................................... <br /> <br />HEiGHf; 22 ]'Of'AL SQ F't'; 486 S']'OR~ES: 2 RLAN.ACTZON: <br /> <br />DATE <br /> <br />SP <br /> <br /> OFFICE COPY <br />FORM # MC 16.56 REV. 4/90 <br /> <br /> <br />