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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: 888-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am performing work on a property I own or occupy. <br />18maregisteredbu de OR{ ) heautho zed representative <br />of a registered builder. <br />The work will be performed by ~ registered buirder. <br />Other <br />I have read 8nd agree to the terms stated on the reverse side of <br />this document. <br /> <br />SNITNS <br />NO IlO <br /> <br />TYPE: BUILDING PERMIT OR APPLICATION <br /> <br />CONI'RACTOR~ NO. <br />CIAMPI, JOSEPH <br />PO BOCX 9~2 <br />AUMSVI[..LE~.OR 97~25 <br />PHONE: 74~-21~3 <br /> <br /> ITEH <br />BUILDIN~ FEE <br />PLAN REVIEW <br />BUILDING STATE ~URCHARGE <br /> <br /> 9849?28 <br />ARCHITECT/ENGINEER~ NO. <br /> <br />F'HONE: <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />TNIS RECEIPT <br /> <br />BALANCE DUE <br /> <br />QUANTITY <br /> <br />AMOUNT <br /> $32.50 <br /> $2]..,].3 <br /> $1.63 <br /> <br /> $0,,08 <br />$55.26 <br /> <br />$8.80 <br /> <br /> PAYEE: CIAMPI~ JOSEPN 52287 <br /> ~ECEIVE~ BY: PM TYPE: IN CHECK ~: 0 <br /> <br />FOLLO~IN~ MUST BE COMPLETED. IT IS THE RESPONSIBILITY DF THE APPLICANT TO ASSURE T~AT <br />LL NECESSARY INFORMATION HAS ~EEN PRO¥I~ED. <br /> <br /> V DATE ~ <br /> DATE <br /> <br />CITY JURISDICTION: BY ............. DATE <br /> <br />HEIGHT~ SETBACKS: FR 28 <br />TOTAL SQ.FT: 0 LS'-5 <br />STORIES: RS-"5 <br />PI..AN.ACTION: RR'"5 <br />ENERGY PATH: SI: ..... <br /> <br />REMARKS: FOUNDATION UNI1ER EXTSTtNG FAMILY ROOM & GARAGE <br /> <br />OFFICE COPY <br /> <br /> <br />