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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br />· ~ '~ 9: 16:: <br />DATE,~ 08/09/?,j T T MI:._-: ~2 <br /> <br /> PHONE: 588-5147 8:00 - 4,:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> SIGNATURE OF APPLICA~~ <br /> <br />AODRE$S <br /> <br /> 8167 SILVER FALLS FIWY SE <br /> AIJHSVILLE OR 97 <br /> <br /> SAME <br /> <br /> PI,lONE: ~6~-1787 <br /> <br /> TYPE: BUTL:OINr. PERMIT UR APPLICATIOM NO: 9848953 <br /> <br /> CONTRACTOR~ NO, 75100 ARCH[TECT/ENG~NEE8~ MO. <br /> L & M Co~s~ructioo loc <br /> <br /> PHONE= 581-85~ ,~ PHONE: <br /> <br /> ITEH QUANTITY AMOUNT <br /> BUILDIMG FEE $74~ <br /> PLAN REVIEW $48,4~ <br /> BUILDING STATE SURCHARGE · $~.7~ <br /> ZONING SURO-IARGE $~. 73 <br /> ~ TOT~E A~SESSE~ ~FEES <br /> : ,:,RREVIOUS: R~CEIPTS <br /> <br /> P~YEE= L & H <br /> <br />FOLLOWING MUST BE COmPLETElY:: IT'iS:'THE:,'RESPONS~BILZTYOFTHE APPLICANT TO ~SSURE THAT <br /> <br /> SEFT~L,, BY ~ATE : : STORIES: 1 <br /> PLAN. ACTIDN: , RR'~'~ <br /> ENERGY PATH: <br /> <br />CITY ,JUEISDICT,[ON. BY DATE <br />REMARKS: POLE BLDg ' <br /> <br />I EOA~. uc ~-~V, 4/~ OFFICE COPY <br /> <br /> <br />