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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 /> 24HOURCODE-A-PHONE:S88-T904 .~Y~,,,.,.~tC~A ~ ~.~~ <br /> ann performing work o, a property ~ own or occupy, . <br />I 8m a registered builder OR ( ) the author zed repfesen a ive SIGNATURE OF APPLICANT: ,-- <br />Of a registered buUder. <br />Yhe work will be performod by a registered builder. <br />Other <br />I h~ve read and agree ~o the terms stated on the reverse side Ct DATE: <br />this document, <br /> <br />BROCK,, cHARLES <br /> <br />TI-HE: 14:'26:'40 <br /> <br />11576 GROUSE LN <br /> <br />NE <br /> <br />...........................: TAX LOT; OAYEGOSY: <br /> <br /> RESIDENTIAl- <br /> ' ; OCCUPANCY: <br /> : OONSTRgCTION TYPE: <br /> <br />AURORA OR 97B02 ' MARION COUNTYi NO , <br /> <br />SINGLE FAMILY DWELLIHGS ; 4 <br /> <br /> CENTURY ~ MEADOW.S- 4~2 <br />SAHE SITE NUNBER~ ?~-IB3tBS1 <br />PHONE: 678-5287 VALUATION: $15~¢8~.88 <br /> <br /> 58 7~ 4~oe. 5F , HO , YES <br /> <br />TYPE: BUILDING PERHIT OR APPLICATION HO: <br /> <br />CONZ~ACTOR. NO. <br />BROLK~ CHARLES <br />SAME <br /> <br /> 98496~1 <br />ARCHITECT/ENGINEER, <br /> <br />PHONE: 678-5207 PHONE: <br /> <br /> ITEM <br />BUILDING FEE <br />PLAN REVIEW <br />BUILDING STATE ~URCHARGE <br />ZONING SURCHARGE <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />NO, <br /> <br />QUANTITY <br /> <br />AMOUNT <br /> $110,,50 <br /> $71.83 <br /> <br /> $5.53 <br /> <br />$0.00 <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE: BROCK, CHARLES <br />RECEIVED BY: MB .................................... <br /> <br /> 52017 <br />TYPE: CK CNECK ~: 619 <br /> <br />* THIS IS NOT A PERMIT. THis APPLICATION NUST,GO THROUGH A REVIEN PROCESS NHERE THE <br />FOLLOWINC HUST 8E COMPLETE~. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASS~R£ THAT <br />LL NECESSARY I~FORMATION HAS BEEN PROVIBEO. .'~ <br /> <br />PLAN REVIEW.. BY___/..~_,~ ..... <br />ZONING, BY,_.~ ............. <br />SEPTIC: BY DATE ............... <br /> <br />CITY JURISDICTION: BY ............. DATE <br />REMARKS: BU ADDITION TO MS <br /> <br />STORIES: 1 RS"":::" <br />PLAN.ACTION: RR-'~ <br />ENERGY PATH: 1 <br /> <br />OFFICE COPY <br /> <br /> <br />