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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 />have read and a~ree to the terms stated on the reverse side of OAYE~ ........ <br /> <br /> OECOSTA, JIM ............... i .............. I! RESIDENl~AI <br /> <br /> ,L 154 R-~, <br /> 11190 E~lrr. Tq RD NE , ' m ; ' <br />~ OR 9700~ ' [ , <br /> <br />11/~24 E'HLEN RD NE <br />~, OR 97002 <br />~E: 678-176~ ~ SiTE NU~ER: 92-02283 <br /> <br /> I <br /> <br />TYPE: BUILDING PEH~41T OR APPLiCATiON NO: 9040705 <br /> <br />CONTRACTOR, NO, <br />DECOS'rA, JIM <br />11424 ~HLEN R0 NE <br />AURORA, OR 97002 <br />PHONE: 678-176~ <br /> <br />ARCHI'fECT/E.%NSiNEER, NO. <br />PHONE: <br /> <br /> ITEM <br />BUiLDiNG FEE <br />PLAN REVIEW <br />BUILDING S'rA'rE E~URCHARGE <br />ZONIN~ SURCHARGE <br /> <br />QUANTITY <br /> <br />ANCONT <br /> ~58.50 <br /> 44.53 <br /> $3.43 <br /> $3.43 <br /> <br />TOTAL; .ASE~EO FEES <br />PREVIOUS RECEIPTS <br />THIS RECEi P'r <br /> <br />$119.89 <br /> $o.oo <br />$119.89 <br /> <br />8ALJ:C, ICE DUE <br /> <br />RECEIVED BY~ C'I <br />............. . ...................... ,..,;,~-,~.,__..:~- ....... ~ ~- _... <br /> ~ 'rH~s iS NO'[' A PERJYIiT. THI~ APPLICATiONMU~T GO'THROUGH A REVJE~ PROCESS I~HERE THE <br /> FOLLOWING fflUST B~ CC~IPLETED. iT IS THE RESPONSIBILITY OF THE APPLiCAJ~T TO A~SWJRE THA'r <br /> ALL NECESSARY INFORMA]ioN HAS BEEN PROVIDED. <br /> <br />PLAN REVIEW: <br /> <br />CiTY JURtSDiC'fioN: BY ............................ OATE ............................ <br />E.NE. RGY PATH: <br />FR I LS..._/'..~__ .... sP ................... <br /> <br />HEIGHT: FOTAL SO FT: 0 STORIES: <br /> <br />PLAN.ACTiON: <br /> <br />OFFICE COPY <br /> <br /> <br />