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MARION COUNTY BUILDING INSPECTION SENATOR BLDG. NO. 225 220 HIGH STRBET NE SALEM, OREGON 97301 PHONE: 588-5147 8:00- 4:30 24 HOUR CODE-A-PHONE: 588-7904 I am a registered bultder OH ( ) the authorized representative SIGNATURE OF APPLICANT; of a registered builder, The work win be performed Dy ~ registered builder. Other DATE: 09/25/92 TINE: i$:54:~ .... TAX LOT: / CATEGORY; KLEIN, ROGER ' 75290090 I RESIDENTIAL Ii CONSTRUCTION TYPE; ]'oeau~AiNa~:, 9334 FRIENDLY ACRES RD SE 66~+~69-6fV; ~GB; OCCUPANT LOAD: AUNSVILLE OR 97~25 ~HARION COUNTY[ NO ~ S~NGLE F~H[LY DWELLINGS ~ ' ~ NALD0 H~LLS FRU[T FRRH ~2 S~HE ~ .............................................................................................. ~ SiTE NUHBER: 92-05405 PHONE: 585-7460 ~ V~LUgT[0N: $9,800.00 .............................. LOT: ~ BLOCK: ~ll SECTION: ~ ............ TOWN~H ~; ~ RANGE: ,~ lONE; ,~ MAP'. TYPE: BUILDING PERHIT OR APPLICATION NO: 9042759 CONTRACTOR. NO. 58891 HARK ETTEL CONSTRUCTION P 0 BOX 288 AUMSVILLE~ 97525-0000 PHONE: 588-9505 ARCHITECT/ENGINEER, NO. PHONE: ITEM QUANTITY AMOUNT BUILDING FEE $80.50 PLAN REVIEW $52.~3 BUILDING STATE SURCHARGE $4.03 ZONING SURCHARGE $4.05 TOTAL ASSESSED FEES PREVIOUS RECEIPTS - THIS RECEIPT $140.89 $0.00 $140.89 BALANCE DUE $0.00 44827 TYPE: CK CHECK ~: S015 PAYEE: HARK ETTEL CONSTRUCTION RECEIVED BY: cl * THIS IS NOT A PERMIT. THIS APPLICATION MUST GO THROUGH A.REVIEW PROCESS WHERE THE FOLLOWING MUST BE COMPLETED. IT IS THE RESPONSIBILiTY:OF THE APPLICANT TO ASSURE THAT LL NECESSARY INFORMATION HAS BEEN PROVIDED. ZONING: BY ~ ..... DATE_~ - CITY JURISDICTION: BY ........ DATE ......... REMARKS: ADO OF OEN HEIGHT: 22 SETBACKS: TOTAL Sg FT: 280 STORIES: i PLAN.ACTION: ENERGY PATH: 1 OFFICE COPY FORM # MC 1