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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 22§ <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: S88-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />have ¢esd a~J'~e to the terms stated orl the reverse side of <br /> <br />DATE: 09/~0/9S TIME: 9:43:49 <br />BARTOSZ, DANIEL <br /> <br /> 583 55TH ST -- <br />AUMSVILLE OR 973255 <br /> <br />SIGNATUFIE OF APPLICANT: <br /> <br />c~NTIAL <br /> <br />~N~fRUC~ION TYPC'; COCUPANC¥; <br />55-1,1 M-1 <br /> <br />USE O~ sul~ol~SlDEliTiAL ACCESSORY STRUCTURE8 <br /> <br /> PO BOX 720 ' <br /> AUMSVILLE~ OR 97325 ~ITE NUNBER: <br /> PHONE: VALUATION: $4~ 8~. <br /> <br /> MAP: <br /> <br /> 25 8S 2W . RS <br />~WIDTH; DEPTH'. ; AREA'. ;UNITS'. ; IR~. LOT: <br /> <br />TYPE: BUiLDIHG PERHIT OR APPLICATIOH NO: <br /> <br />CONTRAC?R~ NO. 2555902 <br />Nichol~ Construct&co <br />12164 W Stayton Rd <br />Aumsville~ 77~25-8088 <br />PHONE: <br /> <br /> ITEM <br />BUILDING FEE <br />PLAN REVIEW <br />BUILQIN6 STATE SURCHARGE <br /> <br /> ~58~1~ <br />ARCHITECT/ENGINEER, NO. <br /> <br />PHONE: <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY AMOUNT <br /> $50.58 <br /> $72.,8~ <br /> $2.53 <br /> <br />$85.8~ <br /> $8.88 <br />$855.86 <br /> <br />BALANCE ~UE $8.08 <br /> <br />PAYEE: Nichols Construction <br />RECEIVED BY: PM .................................. <br /> <br /> 552697 <br />TYPE: tN CHECK ~: 8 <br /> <br /> THIS IS HOT A PERHIT. THIS APPLICATION HUST rd] THROUGH A REVIE# PROCESS WHERE THE <br />FOLLOMIHC HUST BE COHPLETE~. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> <br />LL NECESSARY INFOR~ATiOH HAS BEEN PROVIDED. <br />PLAN REVIEW: <br /> <br /> CITY JURISDICTIOM: BY ........ ~ATE ......... <br /> REMABKS: STORAGE BLDG <br /> <br />HEIGHT: SETBACKS: FR 28 <br />TOTAL SQFT: 488 LS-8 <br />STORIES: 1 RS-8 <br />PLAM.ACTION: AR-8 <br />ENERGY PATN: SPZ___ <br /> <br />OFFICE COPY <br /> <br /> <br />