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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br />SINGLE FAMILY DWELLINGS <br /> <br /> ,, PHONE: 588-5147 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 ,~ . <br />I'¢"am perfo~,~ing work on apropertylown or occupy, <br /> I am a registered ~uilder OR ( ) the authorized representative S~GNATURE OF APPLICANT~~ <br /> of a registered budder. -- <br /> ) The work will be performed by a registered builder. <br /> Other_ <br /> ) ~ have read and agree to the terms stated on the reverse side of CATE; <br /> th~8 document, <br /> <br /> D~TE: <br /> OWNER: TAX LOT: CATEGORY; <br /> ~UNCH, JAHES 56418000 <br /> SITUS ADDRES~ , CONSTRUCTION TYPE: <br /> <br /> 10584 MILL CREEK RD SE :CG~d~Ci~%~ ~U; :OCCUPANT LOAD: <br /> ~UHSVILLE 0R 97525 .H~RION COUNTY; N0 <br /> <br /> : N0 0F 8EBR00MS: <br /> <br /> SITE NUMBER: <br /> PHONE: VALUATION: $16,000.00 <br /> <br />LOT'. BLOCK; : SEC"¢I~ N: ~ ~'~ i'151 ........ ~N~i : ~O~ MAI:'; <br /> ~ ............ i ....I.N : <br /> ~ , NO ' NO <br /> <br />TYPE: BUILDING PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. 47711 <br /> G A Hadley Builder IRc <br />2157 Broadv~em Ct NW <br />Salem, 97504-0000 <br />PHONE: 581-87~6 <br /> <br /> ITEM L~ <br />BUILDIN~ FEE <br />PLAN REVIEW <br />BUILDING STATE SURCHARGE <br />ZONING SURCHRRGE <br /> <br /> 9045508 <br />~RCHITECT/ENGINEER, NO. <br /> <br />PHONE: <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY <br /> <br />AHOUN'I <br /> $116.50 <br /> $75.7S <br /> $5.85 <br /> $5.85 <br /> <br />$203.89 <br /> $0.00 <br />$203.89 <br /> <br />BALANCE DUE $O,00 <br /> <br /> PAYEE: G A Hadley~8~l~ Inc 45596 <br /> RECEIVED BY: HB ~..V...~jC~ _ TYPE: OK CHECK fi: 4~60 <br /> · THIS IS MOT A PERMIT. THIS APPLICATION MUST GO THROUGH A REVIEW PROCES9 WHERE THE <br />FOLLOWING MUST BE COMPLETED. IT IS THE RESPOHSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> <br />LL NECESSARY INFORN~Ti/OH HAS BEEN PROVIDED. <br /> <br />SEPTIC: BY -Z~ZZ~Z]~]~- DATE~ r <br />CITY JURISDICTION: BY ........ DATE <br /> <br />REMARKS: ADDITION BATH AND UTILITY RELOCATION <br /> <br />HEIGHT: 15 SETBACKS: F:R '~ <br />TOTAL SQ FT: ~30 LS'V%!:T <br />STORIES: 1 RS-;;--' <br />PLAN.ACTION: RR]~% <br />ENERGY PATH: 2 SP ......... <br /> <br />~OR~ ,~ MO ~s-se.Bv, 4/eD OFFICE COPY <br /> <br /> <br />