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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 />lamareg~steredbuilderOR( )the&uthodzedrepresentative <br />of 8 registered builder, <br />The work will be pedormed by a registered builder. <br /> <br />gATE: <br /> <br /> m <br /> , ~N~AOT CITY: I UGh: I O~ANT, LOAD: <br /> <br /> I" HOI'IE. 676--J87~ : VAJ.,UA f ]~ON 108~ 490,, 0~ ': <br /> <br />TYPE: DNELLtN~ PER~iT OR ~PPLI~ATION NO: ~45~25 DP <br />COHTRACTOR,i.,tOWARD,~F,O BOX 412J0?!l'lNO"& JEAH ~ARCH:[TI~CT/E]qG~ NEI[;'~ <br />AURORA,, OR 97~2 <br />F'I,40 N E'.i 678-5870 HONE: <br /> <br /> ITEM <br />I)WE, L,I_IHG BU'.I]...D]'.Hf_; FEE <br />I)IJ!EI..L 3: N(; F'LtJHBZNG <br />I)WE:I_L.:[N6 HEE:HAN]:CAL <br />DWEL,LIMG ELECTRICAL, <br />;DWEL,LIN[; STATE SLCRCHAREE <br />Dt:~EI.,.LIN(;, PLAN REVIEW <br />DWEL, L, INE; ZONING SURCHARGE <br /> <br />~ . I ,'-&~UANTI'f'Y <br /> <br />AHOIJNT <br /> <br /> 96 <br />.00 <br /> <br /> TO1AI,,. AooES,~ED FEES · <br /> :'REVZ~.JJ.S RECE"PTS /""~,...., <br /> TH:rS" RE. CE IPT ~ ~ <br /> BALANCE DU~ <br /> PAYEE: HOWARD~ JOHN & ,,JEAN ~ ~ , ~ j <br /> REE, EIVED BY: F'M . ~ TYPE: [,K [;HEuK~: 534 <br /> <br /> FOLLOWING MUST BE COMPLETED. IT IS THE RESP~I~I~OF THE APPLICANT TO ASSURE THAT <br /> LL NECESSARY ~NFORNAT~ON HAS ~EEN P~~i ~ ~ <br /> <br /> 2.0HING: ~Y .............. %-- D~TE~-~ ........... Z ........ ~~ F'T~ ~9)6 q ......... <br /> SEF'T:[C ::::::::::::::::::::::::::::::::::::::: :l. .......... <br /> . ........... <br />~ ~RE~RKS: NE~ FdES, ~[JTR-: ........................ -'~-' <br /> <br />FORM # MC 1E.5~ REV. 4/~) OFF~CE COPY <br /> <br /> <br />