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MARION COUNTY BUILDING INSPECTION SENATOR BLDG. NO. 225 220 HiGH STF~EET NE SALEM, OREGON 97301 PHONE: 588-5147 8:00 - 4:30 24 HOUR CODE~A-PHONE: 588-7904 I am performing work on a DrOperty I own or ocoupy. I am a registered builder OR ( ) the authorized representative SIGNATURE 0¢ APPLICANT: of a registered builder, The work win be performed by a registered builder. Other I I~ave read and agree to the terms stored on the reverse side of DATE; ................. this document. iSITUS ADDRESS; ......................................... ; CONSTRUCTION TYPE: AUHSVILLE OR ~7~25 ; AU~SVILLE NO 5494 NARION RD SE TURNER OR 97392 PHONE: 769-5597 i ....... NE,REI,F~6L-~DDI~QN ........................... VALUATION: $8~500.00 TYPE= BUILDING PERMIT OR APPLICAT~OH NO= CONTRACTOR.. NO. 91274 CALVIN R. MARSHALl. 5494 MARION RD SE TURNER~ 97~92-0000 PHONE: 749-.~597 ITEM BUILDING FEE PLAN REVIEW BUILDING STATE SURCHARGE 9~496~1 ARCHITECT/ENGINEER~ NO. PHONE: QUANTITY AMOUNT $74.58 : $48.45 $3.73 TOTAL: ASSESSED: FEES $126. &$ 'PREVIOUS RECEIPTS Se. 8~ PAYEE: CALVIN R. MARSHALL $92.66 51964 ~ THIS IS HOT A PERM[T. THIS'APPLICAT~OH:~HUSTGOTHROUgH A REV[E~ PROCESS ~HERE THE FOLLO~IH~ MUST BE COHPEETEDE: ITISTH£:RESPOMS~BILIT¥ OF-THE APPLICANT TO ASSURE THAT LL HECESSRRY [HFORHATIOH' H~SBEEH PROVIDED, PLAN REVIEW: BY . ~ DA~E HEIGHT: Z£)NIN~: BY ......... 7 DAIE--?,,T=-~T--- TOTALiSQ FT: SEPTIC: BY-ZZZZZ"ZZZZZZZZZZ DATE ............. STORIES: CITY JURISDICTION: BY ............ DATE ......... ENERGY PATH: REMARKS: FOUNDATION ONLY SETBACKS. FR 56 RS"-8 RR-30 sP'": .... OFFICE COPY