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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLOG, NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br /> 24HOURCODE-A-PHONE:588-7904~X~// <br />I am ptcrforrning work on a property I own o¢ o~,ccupy. ~ f~ ~- <br />~ am 8, registered builder OR ( I the 8uthorfz~d rep~eserKatfve SIGNATURE Off APPLICAN1~ ~"t¢ <br /> <br />Other__ <br /> <br />OWNE~ DA'I'E~ 09/:1,5/e'3 'fINE= ~,6~ ~6~ ~ TAX LOT <br /> 6[~ ~EVEL. Op~ENT <br /> <br /> ],2~94 EHLEN RD NE CONTraCT ;~v. u~ <br /> CUROR~ OR 97ee2 H~RION COUNTY NO <br /> <br /> F'I,,IOI,IE: 678,,d, 020 <br /> <br />LOT ! BLOCK: SEQTION TOWNSHIP'. RANGE <br /> <br />SITE HUMBER= <br />VALUATION: <br /> <br />COHf~ERC I AL <br /> <br />MAP: <br /> <br />........... 4 ~._~2_..._AC ......... NO NO <br /> <br />CONTRACTOR~ NO,, <br /> S'tar~dard Utility <br />PO Box 1008 <br />Salm% 97~08-0000 <br />PHONE~ 882--1475 <br /> <br /> ITEM <br />BUIL. DIHG FEE <br />PLAN RE:VIEW <br />BUILDING ~.~'FATE SURCHARGE <br />ZONING SURCHARGE <br /> <br /> ?~49934 <br />ARCHITECT/ENGINEER~ NO. <br /> <br />PHONE: <br /> <br />TOTAL ASSESSES FEES <br />PREVIOUS RECEIPTS <br />THIS RECEI' PT <br />BALANCE DUE <br /> <br />QUANT I TY <br /> <br />A~OUNT <br /> $80.50 <br /> <br /> $4,,0~ <br /> <br />$140,89 <br /> $0.00 <br />$1.40.89 <br /> <br /> PAYEE: STANDARD U~,~./f~'r'~fl~lOi? INC 52~31 <br /> RECE]:VE~ BYI~ t4~ i]_~,,~ TYPE; CE CHECK ~ 15223 <br /> <br />~ THIS IS NOT A PER~IT. THIS APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST BE COMPLETE~. IT ~S THE RESPON$IBILITYOF THE APPLICANT TO ASSURE THAT <br /> LL NECESSARY INFORMATION HAS BEEH PROVI~EB. <br /> <br /> .... <br />ZONIN?, E,Y._..,. -- '--~---~-~-I ............. DA~E,.;,~.:~C~:~.EEE..4~,,~_.. TOTAL SQ FT= ~ , o'""-'"'>- <br /> PLAN. ACTION~ R R-~b'"- <br />CITY JURISD, ,T~ON, BY DATE ENERGY PATH: ,SI:'- ........ <br /> <br />REi'dARKS~ FOUNDATION FOR MS OFFZCE/SS:HT PER DON W,, HT PER~IT GOOD FORONE YEAR.~ <br /> HOOK UP NOT AVAIL WILL HA~E TO PUT IN SEPTIC ~YSTEM <br /> <br />IF CNW ,F,,R <br /> <br />OFFICE COPY <br /> <br /> <br />