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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 />lamaresisteredbuilderOR( )theauthorizedrepresent~tlve <br />of a registered builder, <br />The work wil~ be performed by a feglstered builder, <br />Other <br /> <br />SIGNATURE OF APPLICANT: <br /> DATE; <br /> <br /> SM:rTH,¢ PATSY J 57¢;~56-000 i RESII)ENTIAL <br />SITUS ADDRESS'. ~N~R~U~ti0N ~YP~; ; OCCUPANCY; <br /> <br /> 9~,~ SMITH RI) SE · <br /> AUHSV~:LI._E OR ~7325 ' MARION COUNTY; NO <br /> <br /> AEJ~.[CUL. fOhAL STRUCTURES <br /> <br />SAHE //~ SITE NUNBER: <br /> <br />TYPE: BUILDING PERMIT OR APPLICATION NO: ~50233 <br /> <br />CONTRACTOR, NO. ARCNITECT/ENGINEER~ NO, <br />SNITH.~ PATSY J <br />SAHE <br /> <br />PHOi,IE~ 74~-2S45 PHONE: <br /> I I'EM <br /> <br />£~OAN'F ;i;TY AMOUNT <br /> ,~.1 <br /> <br /> TOTAL ASSESSED FEES $0.00 <br /> PREVIOUS RECETPTS $0. 00 <br /> THIS RECEIPT <br /> <br /> BALANCE DOE $0., 00 <br /> <br /> PAYEE: <br /> RECEIVED BY: F'H2 · TYPE: CHE(.K-' <br /> <br /> ~ TH[S iS HOT A PERMIT. THIS APPL[6RT~DH MUST, GO THEBUGH A REVIE~ PROCESS WHERE THE <br />FOLLOWING MUST BE COMPLETED, THE APPLICANT TO ASSURE THAT <br />LL NECESSARY INFORMATION HAS BEEN PROVIDED. <br /> <br /> . SETBACKS: FR~.__ <br /> SEPTIC: BY ................ --,- DATE-------.-- ~ STORIES: <br /> ::. PLAN; ACTION: <br /> C~'I'Y JURISDZCT]:ON: BY ........... DA~E_% ............. ENERGY PATH: ~- ............ ..... <br /> REHARKS: QT - A6 EXEHF'T ~TRUCTURE <br /> <br />OFFICE COPY <br /> <br /> <br />