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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; 588-8147 8:00 -, 4:80 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />[ ~ffl pepforming work on a property I own or occupy, <br />l am a registered builder OR ( )theauthprizedrepresentative <br />of a registered builder, <br />The work will be performed by ~ reRistered builder. <br />Other_ <br /> <br />SIGNATURE OF APPLICANT: <br /> <br /> RATE: <br /> <br />:OWNER: BATE; 02/~-8/'95 <br /> SCBI'T 'rOM <br /> <br /> 51.5 _1. ST <br />AUHSV]~LLE <br /> <br />TINE: i1:51_'30 <br /> TAX LOT: <br /> <br /> _q7747,-000 <br /> CONSTRUCTION TYPE: <br /> <br /> N CONTRACT CITY: UGB: <br /> OR 97325 ~DHSVZF...L.E : NO <br /> <br />USE OF BulLDIRG: <br /> RES'rBEWI'IAL ACCESSORY STFCUBTUBES <br /> <br /> RES I DEN <br /> OCCUPANCY: <br /> <br />, NOl <br /> <br />PO BOX .594 <br />AUNSVILLE OR 97325 <br />PHONE: 749-3407 <br /> <br />LOT: BLOCK: SECTION: <br /> <br /> SITE NUMBER: 95-00625 <br /> VALWATION: $1.3,824.00 <br />ToW~sHl~i ;RANGE: iZGN~: MAP: <br /> <br />14/ <br /> <br />TYPE: BUILDING PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR NO. <br />SB01'r TON <br />PB BO~ 594 <br />~UNSV~L. LE OB 97~25 <br />PHONE: 74%"5407 <br /> <br /> Il'EH <br />BUlL. DING FEE <br />PLAN REVIEW <br />BUILDING STATE SURCHARGE <br /> <br /> 9045597 <br />ARCHITECT/ENGiNEER, NO_ <br /> <br />PHONE: <br /> <br />TOTBL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />qOANTITY <br /> <br />~HOUN'r <br /> $t04_50 <br /> $6'7.95 <br /> $5.23 <br /> <br />$ ,1 ? 7 .. 66 <br /> $0. OO <br /> <br />BALANCE PDE $0..0O <br /> <br /> RAYEr" SCOTT, ')~ ~/~ a .... <br />2 ~ !: ~ ! ~ ~ !! 2 ,( ,:!. Z ~.,,.; ::,..: ==-:..~ ...................... L ~ ~ E ~ ,. {! ~ ~., ~. ~ !:! !! ~ ~_ !; !... ,.. ? ........................... <br />* THIS IS NOT A PERMIT. THIS APPLICATION MUST 80 THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MU$[ BE COMPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> <br />iL NECESSARY iNFOR?~/~N/~// HAS BEEN PROVIDED. <br />~ONJNG: ~Y fZZZ .............. DaTE ............... <br />~; E P T~ c: B v2'LLT/~ZZZ:;:Z]ZZ7 ~ ~ T ~ZZ]7777ZZZZZ] <br />CITY 5URISOICT~ON: BY .............. DATE <br />REMARKS; FBLE 8LDG STG <br /> <br />hEIGHT; 17 .~,.,fBM, K~: FR..20 <br />TOTAL $~ FT; 1152 L8...8 <br />STBRIE8: 1~ IRS,,, ¢ <br />PLAN ,, ACT I ON: RR-~B <br />ENERGY PATW: SP' ...... <br /> <br />FORM # MC ~ 5-66 REV, <br /> <br />OFFICE COPY <br /> <br /> <br />