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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-PRONE: 588-7904 <br /> <br />I am performing work od a broperty I own or occupy· ?~i~=~_ . .~I~I~;;L=~ ~....____~ <br />I am a registered builder OR the authorized representative S~GNATURE OF APPLICANT; <br />of a registered builder, <br /> <br /> .. 0,)/,.,?/?~ TIML.. J. 1.49.,,~2 <br /> <br />MA~UNaaDOR~S~[DENTIAL ALLE.~SORY STRUCTURES <br /> <br /> ! EVERGREEN NH PARK <br /> 41827 KINGSTON LYONS DR <br /> S'fAYTON OR 97~8~ SITE NUMBER: <br /> <br /> 5~ '/o ozuu., SF Nd' ' N'O <br /> <br />TYPE: BUILDING PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR,~ NO. <br />MITCHELL. TOD'O <br />4],817 KINGSTON LYOIIS DR <br />STAYTON OR <br />PHONE~ <br /> <br /> ~ TEM <br />BUILDING FEE <br />PLAN REVlLW <br />BtJILD~:NG STATE SURCHARGE <br /> <br />PAYEE: <br /> <br /> 4549~ <br />ARCHITECT/ENGINEER~ NO, <br /> <br />PHONE: <br /> <br />~'F, IS RECEIPT <br />BALANCE DUE <br /> <br />QUANTITY <br /> <br />AMOUNT <br /> $~8.50 <br /> <br /> $1.93 <br /> <br />$(5., 80 <br /> <br />$0.00 <br /> <br /> RECEIVED B/. F'B TYPE: CHECK ~: 0 <br />~ THIS IS A VALID PERMIT, THIS PERMIT EXPIBES 18~ DAYS FROM ITS ISSUE DATE. IF <br />CONSTRUCTION CEASES FOR A PEEIO~ OF 18t DAYS~ OR IF CONSTRUCTION FAILS TO ~EET ALL <br />EQUIREHENTS OF STATE LAWS AND HAEION COUNTY BUILDING AN~ ZONING ORDINANCES, THIS PERMIT <br /> ALL BECOME NULL ANB VOID. ' ' <br /> <br /> HE]:GHT: 1~ SETBACKS: F'R i8 <br /> TOTAL, SQ ET: 26~ LS'"'/ <br /> ENERGY F'ATH:; 'STORIES:' 1 R S~'~;6 <br /> ENER6Y F~'TH, }~¢_. 10 <br /> <br /> I~EMARKS:: CARPORT <br /> EY~ HARd;ON COUNTY BHIL~IN~ OFF,H,;IAL / BY ................... ~_ .................................................... <br /> <br />FORM # MO ~5-~ REV. 4/[~0 OF FICE COPY <br /> <br /> <br />