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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NC), 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 /> I am performing work on a property I own or occupy. <br /> I am a re(listered builder OR the authorized representative <br /> of a registered builder. <br /> TMe work will be pedormed by a regis ered builder, <br /> Other <br /> I have read and agree to the terms stated on the reverse side of <br /> <br />::. ;~3/].9/9% TIME: 9~:26:04 <br />;OWNE,: I,,U,CA,% M.dU-IC~E:L <br /> <br />SITUS ADDRESS; <br /> 7,~ Ot,,,HE,¥ ST <br /> <br />LO*D: <br /> <br />'MAILING ADDRESS: SUBOI~I,',T,L 2 <br /> PO BOX 29B <br /> At,IMSV:[L_L_E 97325 S][.¥E- -N~M;I~RI. ---~-;~_11~§~r78! <br /> PHOHE= 747--J. 265 VALUA'IZON: $:i, 4~4e8, e~ <br /> <br />CONTRACTOFL, <br />L. UCAS.~ MICHAEL <br />PO BOX 298 <br />AUHSV:[I_I_E 97Lt25 <br />PHONE: 749-1265 <br /> <br />ARCHI TECT/F'NGINEE;R ~ <br /> <br /> ITEM <br />[4UILI);[NG FEE: <br />F'L,AN <br />BU:i],,,I)IHG STATE SURCHAR£;E <br /> <br />PHONE: <br /> <br />TOTAL ASSESSEI) FEES <br />PRE¥IOUS ~ECF.11PTS <br />TI-lIS RECEIPT <br /> <br />CJUANTITY <br /> <br />$71.83 <br />$ 5. d 3 <br /> <br />$i87.8& <br /> $0.00 <br />$187.86 <br /> <br /> BALANCE DUE $0.. 00 <br /> RECEIVED BY: PB ..,, .~,,,..~. , <br />~ THIS IS MOT A PERMIT. ~HIS APPLICATION MUST CO THRQUCH A REVIEW PROCESS WHERE THE <br />FOLLOWIN~ MUST BE COHPLETEB. IT IS THE RE~PONSIBILITYOF THE APPLICANT TO ASSURE THAT <br /> LL NECESSARY INFORMATION NAS BEEN PROVIDE~. <br /> <br />PLAH <br />ZONING= <br />SI{PT I C,~ BY ...................................... DATE ................................ <br />CITY JO~ZS~ZC'fIOH:i BY ~ATE <br />REMARKS'.'. CAI AGI. <br /> <br />HEIGHT: 15 ,SETBACKS: F'R 20 <br />TOTAL SQ Fl': '~.200 LSiZ5 <br />STORIE~: 1 RS 5 <br />PLAN~ ACTION: R R:i'i5 <br />EI,IEF~GY F'ATH,~ SP .......... <br /> <br />~O~M # MC ~s.s~ ~,. ~ OFFICE COPY <br /> <br /> <br />