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MARION COUNTY BUILDING iNSPECTION <br />SENATOR BLDG. NO. 225 <br />220 H~GH 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 have read and agree to the terms ¢tatod or~ the reverse <br /> <br /> 105 BkE1TENI!USH RD <br /> DEI'ROIT OR 97S4~ <br />U~E OF BUILDiNG~ <br /> <br />DETROIT <br /> <br /> CA'rECOPY: <br /> <br />; O(~M~ANf LOAD: <br /> <br />LOT: <br /> <br /> HAMMONI) <br />50,.58 C14ARI_['"-STOi,I DR <br /> <br />I HONE.. 588,.,,~432 VALUATION: $972,00 <br /> BLOCK: aEC+ION: : TOWNSHIP: :' ~N~: : ~5N~: MAP: <br /> <br />1,3~ ' :l,'l ¢ ' ~4gg~,, gF IqR YES <br /> <br />TYPE: BUILDINg PERMIT OR APPLICATION NO: <br /> <br />CON,,T, RACI'OR,, <br />FF( I !~I"IM At,I ,~ DENNIS <br />5058 CHARLESTON <br /> <br />PMONE: ~88--94;;',:! <br /> <br /> ITEM <br />BUILDINg FEE <br />PLAN REVIEW <br />BUIL]))'.NG STATE SURCHARGE <br /> <br /> 9845791 <br /> <br />ARCH], 1 ['-C]/E. ML~II'EI:k~ NO,. <br /> <br />F'H 0 NE: <br /> <br />TOTAL ASSESSEP FEES <br />PEE',VIOUS RECEIF'TS <br />THIS RECEIil <br /> <br />QUANI'II'Y <br /> <br />AMCUNT <br /> ~l;J. 7,, 50 <br /> <br /> $0.88 <br /> <br /> $0.00 <br />$29,76 <br /> <br />~AL, ANCE DUE $0,00 <br /> <br /> PA'(EE; F'I~:[SHMAN,~ DENNIS ~ 47993 <br /> [~ECEIV[:~ BY~ F'~ ~ 'fYPE: IN CHECK ~: 0 <br /> <br /> ~ THIS IS NOT A PERMIT. TNIS APPLICATION MLIST 60 TNROUgN A REVIEW PROCES~ WHERE TH <br /> E <br />FOLLOWING MUST BE COMPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> LL NECESSARY INFORMATION HAS DEENPROVIDED. <br /> <br />ZOI!]:N[;: [IY // ' ' ....DATE ......... <br /> ,7SS'"1 <br />CITY JURISDfCTIoN.~ BY ................ DATE .................. <br /> <br />REMARKS; DECK ONTO ,~EF:VICE or'fATION <br /> <br />HE:£GIiT: SEI'BACi':{S :'. FR....~I <br />TOTAL se FT.". 2:1.6 LS 0 <br />STORIES: <br />F'LAN. ACTION: RR-O <br />ENERGY F'ATPt~ S F".~ .......... <br /> <br />OFFICE COPY <br /> <br /> <br />