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220 HIGH STREET NE g <br />SALEM, OREGON 97301 <br /> <br /> PHONE: 588-514'7 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> I 8m performing work on a property I own or occupy, <br /> lam a registered builder OR( )theauthonzed representative <br /> of a registered budder, <br /> The work will bo performed by 8 registered builder. <br /> Other <br /> I have read and agree fo the terms s~ated on the reverse side of <br /> this document. <br /> <br /> DATE: 05/0?/92 Ytr4E: 12;:UE236 <br /> <br /> EMERY, ADRIAN [% ,JR_ ~ JANET <br />SITUS ADDRESS. <br /> <br /> 130 LAKECR~T DR <br />£)ETRO]! T OR 97~42: <br /> <br />· MAILING ADGR~SS; SINGLE FAI~IlLY DWELLJ. Nr,:~ <br /> <br />TAX LOT <br /> 90250~020 <br /> <br />CONSTRUCTION TYPE <br /> 5-N <br />CONTRACT C)TY UGE <br />DETROIT NO <br /> <br />SLJBD~VISION; <br /> <br />PATTON ADD <br /> <br /> PO BOX 489 <br /> AUNrCVI LLE DR <br /> PHONE: 749-2624 S['T'E NUMBER", <br /> VALUAT <br /> <br />~-OT. ; BLOCK: SECTION TOWNSHIP: RANGE <br /> 3 1 01 10 <br />WIDTH DEPTH. AREA. iJ NITS RREG. LO'I <br /> 92 - 78 163?6 . 5P <br /> <br />CATEGORY <br /> RES1DEN'f IAI <br /> <br />OCCUPANCY <br /> <br />)CCUPANT LOAC <br /> <br />92-01760 <br /> $50.000.00 <br /> <br /> RS <br /> <br />TYPE: DWELLING PE~i'F OR APPLICATION NO: 9039840 DP <br /> <br />CONFRACTOR, NO+ <br />ENERY, ADRiAN C. JR. & JANET <br />PO BOX 439 <br />AUNrSVILLE OR 9?325 <br />PHONE: ?49-2624 <br /> <br />ARCHiTECT/ENGINEER, NO. <br />PHONE; <br /> <br /> l'f'F_~ <br />DWELLING BUILDING FEE <br />DWELLING PLUMBING <br />0~ELLiNG MECHANICAL <br />0WELLING ELECTRICAL <br />[:,~ELLING STATE ;:SURCHARGE <br />D~ELLiNG PL~ RE¥IEW <br /> <br /> QUANTiI'Y <br /> <br />TOTAL A~ED <br />PRE¥~OO~ R~CE~P'['~ <br />THi~ RECEIPT <br /> <br />BALANCE [~JE <br /> <br />PAYEE: EMERY, ADRIAN C. JR. & JANE'r E. ~ , <br />RECEIVED BY: P8 ~/_..2, 'TYPE: [N CHECK <br /> <br /> $156.39 <br /> $57,03 <br /> <br /> 44.53 <br /> $13+61 <br /> $185,00 <br /> <br /> $470.'17 <br /> $o.oo <br /> $470_7'~ <br /> <br /> $0.00 <br /> <br />41882 <br /> 0 <br /> <br />* THIS IS NOT A PERMIT. 'mis APPLICATION fvEJaT GO 'FHROUf,.~ A REVIEW PROCE~ i,'~tERE THE <br />P'OLLOI~ING IvlUST BE COFIPLETEO. il' tS THE RESPONSIBiLiTY OF 'THE APPLICANT TO A~,,~URE THA1 <br />ALL NF_~RY INFORMATION HAS BEF_N PROVIDED. <br /> <br />HE~GH'1: O TOfAL SQ P'T: 972 STORIES: 2 PLAN.ACTION: <br /> <br />OFFICECOPY <br /> <br /> <br />