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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 /t/r"~, <br />I am performirK~ work on a property I own or occupy, <br />I am a registered builder OR ( ) the authorized representative SIGNATUHE <br />of a registered builder. <br />The work will be perforrAed by a registered builder. <br /> <br />OWNER; <br /> I)AI'E',', 0o/~,.:)/?,~ 'T,T,~EI; ..~. o7 45 <br /> <br />sinus AB,r~s~'USt.iEZ,~ DAN <br /> <br />TAX LOT~ <br /> <br />CONSTRUCTION TYPE: <br /> <br /> CATEGORY: <br /> <br />o~q.?d~:ilqT ]:Al_ <br /> <br /> :L~183:L ARt,I;)T R~ <br />USE OF BO LB I~¢,If~'(,I{~A <br /> <br /> FIE <br />DR ?7002 MARION COUN'fY NO <br /> <br />MAILING AOOR~:NGi,.E F'AMIL. Y <br /> <br />SU BDIVI510N: <br /> <br />LOT; <br /> <br />WIDTH: <br /> <br />~u <br /> <br />TYPE= ]BUILDING <br /> <br />O01,]'T'Ir~ACTOI% I,lO ,. <br />HAR-fLISHE;Z~ ' DAN <br /> <br />PERHIT OR APPLICATION NO: <br /> <br /> ~04727& <br />ARCHITI£C-F/EI,IGINE]SI% <br /> <br />NO. <br /> <br />PHONE: 678-2660 PHONE:: <br /> <br />BU]iLDING FEE <br />F'LAN REVIEW <br />BUIL~];NE, SI'ATE ,SURCHARGE <br />ZONIHf; SURCHARGE <br /> <br />FAYEE~ MAR'FUSHEZ,~ DAN <br /> <br />TOTAL ASSESSED FEEo <br />F'REVIOtJ8 RECEIPI'8 <br /> <br />Q U A N T I 'F Y <br /> <br />AMOUNT <br /> $376.00 <br /> $244.40 <br /> <br /> $18.80 <br /> <br />$650.00 <br /> $0.00 <br /> <br />BALANCE DUE $0.00 <br /> 49557 <br /> <br /> RECEIVED BY: PM TYF'E= CK CHECK ~: 240~ <br />~ THIS IS NOT A PERMIT. THIS APPLICATION MUST ~ THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST BE COMPLETE~. IT IS THE RESPONSIBILITY OF THE ~PPLZCANT TO ASSURE THAT <br /> LL MECESSARY INFORHATION HAS BEEN PROVIBEB. <br /> <br />FL. AH M:_V I E <br />SIEF'F]:C= [~Y;:T~,,~',_,...]]]'"-'J'5"- DA'rtE"]2~%'~,,.~,.~.,, <br />C:['TY JtJR1S!~:/C'Fi:ON: BY .................. :OATE .................... <br />i ~:NARK.:. <br /> <br />Bl,l: FAMII,,,YRH~ K:[TCHEN/]DZN RM <br /> <br /> x OFFICE COPY <br />FORM I~ MC 15-56 REV, <br /> <br /> <br />