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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 />i am a registered b~i[derOR ( ) the authorized representative SIGNATURE OF APPLICANT; <br />Other <br /> <br />OWNER: OAT[E: 83/:t:1./9;~ TI~E: <br />SITUS AO~M''H'~ .JOHN & LAURA <br /> <br />1 1: ~ ,-~5 , TAX LOT: CATEGORY: <br /> <br /> 7~.50LNE"iY ST <br /> AUHS¥II.LE OR <br />USE OF SUILDtNG: <br /> <br />MAILING AODR~%.~:N(;L'E FAi4I[,,y DWEI...LTNt;S <br /> <br />SUBDIVISION: <br /> <br />LOT: <br /> <br />F'O BOX 290 PARCEL :~2 <br />AtJHSV1LI..,E OR 973.,.;g SITE NUMBER: <br />PFIOHE: '749--2~7& VALUATION~ <br /> <br />ZONE: MAE: <br /> <br />80 <br /> <br />AR~5 ~N'~SS ,R ,.,fO, LOT: CORi~: <br /> <br />TYPE: :DWELLING PERMIT OR APPLICATION NO: <br /> <br />CONTRAOTOR.~ NO,, <br />FIORTSf.,H,, JOHH & I..AURA <br />PO BOX 2?0 <br />AUi~SV];I..LE: OR 97325 <br />PHONE: 749-2576 <br /> <br /> I'I"EN <br />BWELLIN[, BUILBING FEE <br />I)W['.::LL ? NG PLOHI!d:NG <br />IOWEI..I..I NG HECHANICAL <br />I)WEL. LIHG ELEC'I"R Z CAL <br />DWELLING STATE SURCHARGE <br />10WELL, lNG PLAN REVIEW <br /> <br />FLOC) b <br /> <br /> 9B45786 DP <br />ARCHITECT/ENEINE:ZR~ NO. <br /> <br />PHONE: <br /> <br />QUAN1TfY <br /> <br />AMOUNT <br /> $337.89 <br /> $123.21 <br /> <br /> $96.21 <br /> $29.40 <br /> $185.00 <br /> <br /> $802.41 <br /> $802.41 <br /> <br /> .¢BALANBE DUE $0.00 <br /> ?YEE: HORTSC~. JOHN & LAURA <br /> RECEIVEI) BY: EB ~'/ 'IY~)F. TU m~¢r~ ~,4770 <br />, T.is ,s .CT A PE,,iT. T,IS APPLIOAT,,, <br />FOLLO"IN~ "UST BE COMPL£TE*. IT IS THE RESPONSIBILITY O~ THE "PPE~CAN~ ~ A~[~[ ~gT <br /> <br />ZOl,l:[ N~: BY <br />SEPTIC: ~Y-'-Y-'"_'22',:;:27Z----'£T2 BATE <br /> <br />CITY ,)LJRISI)IClfION: BY ................... DATE <br />RENARI'(S: NEW RE:S <br /> <br />HEIGHT: SETBACKS: F'R 20 <br />PI. AN. ACTION: ~ <br />ENERGY I:'AIFH: SPI= ........ <br /> <br />~0~ ~ M C ~ Sl S~ ~ ~[ 4¢0 OFFICE COPY <br /> <br /> <br />