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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 225 <br />220 HIGH STREET NE <br /> SALEM, QREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />Iml3 per,ormin9 work on a property I own or Occupy. <br />I am a registered builder OR the authorized representative SIGNATURE OF APPLICANT: (,~. :~, <br />of a registered builder, <br />The work will be performed by a registered builder. <br />Other_ <br /> <br /> 11685 LARK CT FIE <br /> ~...-..~ 7~82. <br /> <br />2~}~1 N MEI,IZIES 9R i CENTURY MEADOWS <br />PORTLAND, OR ~7217 MOBILE 7~-1158 <br />PHONE: 28~-.6~2 <br /> <br />TYPE: BUILDING PER~IT OR APPLICATION <br /> <br />CONTRACTOR, MO. <br />HASCHKE~ LES & BETTY <br />2281N MENZIES DR <br />PORTLAND. OR 77N17 MOBILE <br />PHOI,IE: 2B?--6~62 <br /> <br /> ITEM <br />BUILDING FEE <br />PLAN REVIEW <br />BUILDING STATE SURCHARGE <br />ZONING SURCHARGE <br /> <br /> ~48975 <br />ARCHITECT/ENGtNEER~ NO. <br /> <br />PHONE: <br /> <br /> TOTAL ASSESSED FEES <br /> PREVIOUSRECEI'PTS <br /> THIS, RECEI,PT <br /> <br />.BALANCE DUE <br /> <br />QUANTITY <br /> <br />AMOUNT <br /> $104.50 <br /> $67.93 <br /> <br /> $5.2~ <br /> <br /> $182.8~ <br /> $0.00 <br /> $],82.89 <br /> <br /> $0.00 <br /> <br /> PAYEE: MASCHKE. LES & BETTY 51311 <br /> RECEIVED BY: CL - TYPE: CE CHECK ~: 2405 <br /> <br /> * THIS IS NOT A PERMIT.,' ,THIS APPLICATION HUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING flUST BE COMPLETED. IT ,IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />LL NECESSARY INFOEHAT~ON flAS BEEN PROVI9E~. <br /> <br />PLAN REVIEW: <br />SEPTIC: <br />CITY JURI,BI)ICT:I;ON. BY ................. DATE ............................. <br />~HARKS~ RES/ACC CARPORT <br /> <br />HEIGHT: SETBACKS: FR ~' <br />TOTAL SO FT: <br />STORIES: 1 <br />PLAN.ACTION: <br />ENERGY F'ATH: SP <br /> <br />FORM # MC 1 ~,-~G R~, 4~0 OFFICE COPY <br /> <br /> <br />