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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 /> 24 HOUR CODE-A-PHONE: 588-7904
<br />
<br />ampe ormngwokonapropertylownoroccuPY,
<br />I am a registered builder OR ( ) the authorized representative SIGNATURE OF APPLICAN
<br />of a registered builder,
<br />The work will be pectormed by a registered builder.
<br />Other
<br /> '" DATE;, .,.,~, ~'~, I ~ ~_ .~
<br />
<br />OWNER;
<br /> BISSELL,~ ANNE;TTE ~ 7444~871,~ FdESIDEN'f'IAL,
<br />
<br /> ~ ....... ~' ', ~ARION COUNTY,, NO
<br /> AUH.>V.[LLE OR 973~¢
<br />
<br /> SINf;LE FAHIL,Y DWELI_INbS
<br /> ~ SAHTIAH SPRINGS
<br /> 487e -' 7:[ST AVE SE
<br /> PHONIC: ;~62~6:[~ t ~LUAT:[ON:
<br />
<br /> WIDTH; rDE~H'.~ ........... ~, AREA: ................................................ UN TS; ~ RRE6, LOT ~OORNE
<br />
<br />TYPE: DWELLIN6 PERHIT OR APPLICATION NO:
<br />
<br />COHTRACTOR,, NO.
<br />BISSFLL,,, ANNETTE
<br />4090 - 71ST AVE; SE
<br />SALEH 97301
<br />PHONE: 362-~610
<br />
<br /> ITE~
<br />1)WELL, ING BU'rLDIIIG FFE
<br />DWELLIN6 I:'LUHBING
<br />I)WELL, I NG HECNAN'f CAL
<br />DWELLING ELECTRICAL
<br />DWEL. LII,I(:; STATE SORCHARGE
<br />DWELLING PI. AN RE;VIEW
<br />TUr.:NF.']:KE D/W - BI, DC; INSPECTIOH
<br />TURHPIKE D/W - PO~LIC WORK8
<br />DWELLING ZONTNC- SURCHAREE
<br />
<br />AF(CH[ TEC, T/E N G 1N E E;~:, NO.
<br />
<br />PHOf, E:
<br />
<br />TOTAL ASSESSED F(ES
<br />PREVIOIJS,RE(~E'IPT~
<br />THIS RECEIPT
<br />
<br />QUANTITY
<br />
<br />AMOUNT
<br />$1~867.,,56
<br /> $S89,.28
<br /> $96.98
<br /> $SOS. 98
<br /> $92 ~ 09
<br /> $185.00
<br /> $1.00
<br /> $ ].6.08
<br /> $15.08
<br />
<br />$~.., 167.69
<br /> $0.08
<br />$2 167,, 69
<br />
<br /> (~L~N6E DUE ~ t0,88
<br /> PAYEE (E'qET4 WOODS ~"4...\'.',;/,' , , ~ d1348
<br /> RECE'[VF'D BY~ DH2 '"" , ' TYPE: 6K &HECK 4~: ~856
<br />
<br />* THiS IS NOT R PERHZT, ',THIS APPLICATION HUST ~ THROUEH A REVIE~ PROCESS ~HERE TH/
<br />FOLLO~[HG flUST BE COflPLETED. IT iS THEY RESPOH~[~TY:OF THE APPLICANT TO ASSURE THaT
<br /> LL HECESSRRY INFORHBT[SH HASBEEN,PRO¥IDED.'
<br />
<br />HE);GNI': SETBACKS: F R_...~_~
<br />STORIES,, 2 RS._L~_
<br />
<br />ENE, RGY PATH: 1 SP
<br />
<br />FORM # MC ~-5~ RE',/. 4/90 OF FICE COPY
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