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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: 888-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 888-7904 <br /> <br />I am porforming work on m property I own or occupy. <br />I am a registered builder OR the authorized representative <br />of a registered builder, <br />The work will be performed by a registered builder, <br />Other. <br /> <br />I have read and agree to the terms stated on the reverse side of <br />this document, <br /> <br /> OWNr~.J' E; 10/08/91 f' .i ME '- '[: 3(~) '- ] 9 ! YAX LOT; ~ CATEGORY; <br /> RO~5~R'rS, VINCENT S. <br />SITUS ADDRESS: <br /> ~408~ CESSNA Sf ~~/'' NE ' S~8; ;:6COUPANT LO~'~ <br /> AURORA OR 97G02 <br /> ......................................... '~AR.~ON OOUNYY N~ ~ , <br /> <br /> ................... SUNSE:I: ~ LE gS/:A~'g5 · <br /> WORK 6¢6--8 S~ <br /> <br /> PHONE: 578~5288 i Sif'E NUNiBER: <br /> <br />13 <br /> <br />, : o ,¢,,S I W A,R ' 3 <br />'?O. 100! ?000_ . SF NO NO <br /> <br />IYPE; BL i .Olh .~ PEF'~i'f OR APPLICA'f'ION NO: <br /> <br />CON [RACTOR, NO. <br />ROBERTS, VINC~N'f 5, <br />~OI'~K $36--8'182 <br /> <br /> 9035913 <br /> <br />A -,~,H .... (. / ENG.[,NE~,R, <br /> <br />PHONE: $V8~5288 PPONE; <br /> <br /> ~ TEN <br />BD ILDiNG PEE <br />PLAN REV] EW <br />SL.¢U,.L:)tNG STAf'E SURCHARGE <br />ZON i. NG SURCHAR(}~ <br /> <br />TOTAL ~ESSED FEES <br />PREVIOUS RECEIPTS <br />']'MIS RECEIPT <br /> <br />OUANT i TY <br /> <br />Al'eCU N T <br /> <br /> $!8.20 <br /> <br /> $ 'l, zl. 0 <br /> <br />$o.oo <br /> <br /> BALANCE DUE <br /> <br /> PAYEE: ROBERTS, VINCENT S. <br /> RECEIVED BY: DM2 ................................................................................................... 'f'¥PE: CK CH_CK :¢: '72~ <br /> <br />~< 'tHiS iS NO'f A PEpdVl~'f'. THiS APPLiCA'flON fvlUSf' GO 'THROUGH A REVIEW PROCESS WHERE' 're-tit, <br />POL, LOWINt; MUSI' 8E COMPLETED. i[' IS ":'HE RESPONSiBiLIt'Y OF I'H~' APPLICANT TO ASSURE '¥H.~¥ <br />ALL NECESSARY ,~NFORMAIiON HA~ SEEN PF,~OViDEO. <br /> <br />PLAt'q REV.LEW; [~Y OATE <br /> .... [.fY JUR[~SDIC~!ON: 8Y DATE <br />SEPl iC: ~'-"~Y DA'I E <br /> <br />REMARKS: ~T .......... R~3702''''~ <br /> <br />FO~M/f MO 15-5~ ReV, 4/'90 OF FICE COPY <br /> <br /> <br />