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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 performmg work on a property I own or occupy <br />I am a registered budder OR( )theauthor~zed representatwe <br />o a og°~ e ed b Jilder, <br />The work wi I be ¢erforr'qed by o registered builder, <br />Other .... <br />i i~sve read and agree to the terms stated on the reverse side of <br /> <br />SIGNATURE OF APPLICANT: ....... <br /> <br /> DATE: ..... <br /> <br />ow~A:'¥E: 02/19/91 'riME: <br /> <br />s~usAgoaEs~'rUBBLEFIELD, RON <br /> <br />9;47:22 <br /> <br /> 799 I~M[N ST <br />AUf4SVI LLE . .. OR .9?325 <br /> <br /> 90010-220 / COtW4E~iA~ <br /> <br />:ONTRA~L~ CITY ~%~iB' 'iOGCUPANT LO~D' <br /> <br />"AUI'4SViLLE NO N0 OF 860R00M$ <br /> <br />M~. ~Nn ^o~ss: RES'rAuR.&N'r <br /> <br /> 5253 INtADN'K.'~A HEI(,'~HTS DR <br /> SILVERTON, OR 97381 <br /> PHONE: 873-6616 <br /> <br />LOT St. OCKz <br /> <br />SECflON: TOWNSHIP: <br /> <br />W~UTH 3/4 ~'TH: 10 ^~: 25 UNITS <br /> 75 ,, 108 · 7500'* ...... <br /> <br />SUBDIViSiON: <br /> <br />8S <br /> <br />SF <br /> <br /> AUMSVI LLE ADDi l' I ON <br /> <br />SiTE NUMBER: 12237 <br />,~N~LUA'r ION: ,. ~0N~q-os, 000,. <br /> <br /> R~E~ LOT; '~N CORN~; C <br /> <br /> ........ ~, x,,, ....-~B~ ...... <br /> <br />'TYPE: BUiLDiNG PERMIT OR APPLICATION NOt <br /> <br />CON'I'RACI'OR. NO. <br />STU88LEFIELD, RON <br />5263 f, IAORONA HEIGHTS DR <br />SiLVERTON, OR 97381 <br />PHONE: 873-5616 <br /> <br /> l'rB~ <br />BU1LBiNG FEE <br />PLAN RE¥iE~ <br />BUiLDiNG STATE SURCHARGE <br /> <br /> 30210 <br />ARCHiTECT/ENGiNEER, NO. <br /> <br />r...,~ AN 'I' i 'FY <br /> <br />TO'rAL A,,~P_.~ED <br />PR£ViOUS RECEI PI'S <br />'['HIS RECEIPT <br /> <br />AMCXJNT <br /> ~445.50 <br /> 289.58 <br /> $22.28 <br /> <br />t57.36 <br /> $o.o0 <br /> <br />BALANCE DUE $0.00 <br /> <br /> PAYEE: <br /> RECEIVED BY: PR TYPE: CHECK ~: 0 <br /> <br />~ 'rH~S IS A VALID PBI~IIT · THIS PERf4IT P~PtF~8 180 DAYS FROt,1 iTS i~E DATE. IF <br />CONSTk~Jc'rioN CEASES FOR A PERIOD OF 180 ~fS, OR iF ~S'r~Cl'l~ FAi~ TO REE'r ALL <br />RE~IR~ENI'S OF STATE ~ ~D ~Ri~ ~NI'Y BUILDING ~D Z~tNG ORDIN~CES, THIS PEril' <br />S~LL B~E NULL ~O VOID. <br /> <br />SETBACKS: FR LeS RS RR SP .............. <br />RENARKS: RBVlODEE--~ REPAIR-"FAVERN ......................... <br /> <br />HEIGHT: TOTAL ~ Fl': 4300 STORIES: <br /> <br />EX~ALD B. laK)OOLE¥, MARiON COIJN'rY BUILDING OFFiCiAL / BY <br /> <br />~om4 ~ MC ~.s~ ney. 4/~o OFFICE COPY <br /> <br /> <br />