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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 gerlo ming work on a property I own or occupy. <br />I am 8 regis ered bu der OR ) tho authorized representative SIGNATURE OF APPLICANT: <br />of a registered builder. <br />The work will be performed by a registered builder. <br />Other, <br />I have read and agree to U~e terms staled on the reverse side of <br />this document. <br /> <br />OWNER: DATE: 05/18/93 'TIi"IE: t1:41::49 <br /> <br /> Al, L S["_'ASONS HOTEL/TIM HILLER <br />SITUS ADDRESS: <br /> <br /> 130 BRE:tTr.%IBtJSH ROA[) ..... <br />DETRO];T OR <br /> <br />ST[ ;TURES OTHER THAN BUILDZN[;8 <br /> <br />PO BOX ~ <br />DEfRO:[I, OREGOII 973.4~ <br />P40~E: 854.,-:~42:L <br /> <br />LOT: <br /> <br />TAX LOT <br /> <br />20NSTRUCT~ON TYPE <br /> <br />CONTRACT CITY: JGE <br />D E 'f' R fl) I T N 0 <br /> <br />CATEGORY <br /> <br /> CO~MERC ;I; Al <br /> <br /> SUBBIVIS ON <br /> <br /> HAMMOND <br /> <br /> SITE NUi~BER: 9~-t~1718 <br /> VALUATION: $500.00 <br />BLOCK'. SECT ON'. TOWNG~IIP; RANGEi ' ZONE'. MAP: <br /> <br />WIDTH: DEPTH: AR~ : <br /> UNIT ; <br /> <br />I~. Lof: :CONNER: l ¢~ ~'5 <br />YES NO <br /> <br />TYPE: BUILDING PERMIT OR APPLICATION <br /> <br />,C, OIqTRACTOR~ NO.. <br />AL, L OEA.~;OI,f~i MO'f'EL/TIH HI'LLEF~ <br />PO BOX 52S <br />DE?ROIT~ OREGON 97~42 <br />% ONI::-.: 854-,.;~421 <br /> <br />BUII._:DI N¢ FEE <br />F'LAN REVIEW <br />BUILDJ~HG ,STATE SURCHARGE <br /> <br />F'AYEE: ALI. SEAoOh,, HO'Y'EL/T!H 4ZLI,,EF~ <br /> <br /> 91~47166 <br /> <br />ARCHI TECT/ENG l NI,,i'ER ~ HO. <br /> <br />F'H 0 HE: <br /> <br />[~UANTITY <br /> <br />TOTAL ASSI-'SSED F'EES <br />PREVIOUS 1'4E, CE].F To <br />THIS RECE]:PT <br /> <br />BALANCE DIJE <br /> <br /> AMOUNT <br /> $10,, 00 <br /> $6.50 <br /> $0.50 <br /> <br /> $17,, 00 <br /> $0,, 80 <br /> $17.00 <br /> <br /> $0.00 <br />4<2420 <br /> <br /> RECE;[VED BY: PM .... _ TYF'E: IN {'.I"tECx"' ¢: 0 <br />FOLLOWING MUST BE CONPLETE~. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSU~E THAT <br /> LL NECESSARY INFORMATION HAS BEEN PROVIBEB. <br /> <br />Z{.li,I I N L"-: BY DATE ............................... <br />SEPTIC: BY ......................................... DATE .............................. <br />C]:TY JURISDIBTION: BY ....................... D~TE .................... <br />EL. MAI,J,,,,h, S]:CN RI:I LACEMI:.NT - Al,,,i,. SEASOfb MO'i"EL <br /> <br />FORM # MC 1¢-d6 REV, 4190 OFFICE COPY <br /> <br /> <br />