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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 />I am a registered builder OR ( } the autherized representative <br />of a registered builder. <br /> <br /> OWNI~R'. , TAX LOT: I CATEGORY; <br /> HERN,~ KEVIN ' [ / RESIDENTIAL <br /> <br /> ~ MICHaEl WAY <br /> AUI4S~L[_E "'"- OR <br /> <br />,USE OF BUILDING; ENO. <br /> SINGLE FAHILY DWELLINGS ] 4 <br /> <br /> PO BOX <br /> Ai,IHSVZLLE~ OR . 97525 <br /> F'HONE: 74~-].~5 <br /> <br /> [ , , I ~ , <br /> <br />TYPE: D~ELLING PERMIT OR APPLICATION NO: <br /> <br />CONTRA.C. TOR,, <br />HERN. KFVIN <br />PO BOX 923 <br />AUMSVILLE,, OR . S~7~25 <br />PHONE: 749-.].~1.5 <br /> <br /> I'fEN <br />DWELL, lNG BUILDING FEE <br />DWELLING PLUMBING <br />DWELLIIqG HECHANtCAL <br />DWEI,.LiI:N6 ELECTRICAL <br />DWELI_INI; STATE SURCHARGE <br />DWEI,,,L]:NG PLAN REVIEW <br /> <br />ARCHI'IEOT/ENGINEER~ NO., <br /> <br />PHONE: <br /> <br />TOTAL, ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />BALANCE QUE <br /> <br />QUANTITY <br /> <br />AHOUN'F <br /> $525.49 <br /> <br /> $47.74 <br /> <br /> $4~72 <br /> $185.00 <br /> <br />$1~145.20 <br /> $0.00 <br />$1~145.20 <br /> <br /> PAYEE: HER{% KEVIN 51514 <br /> RECEIVED BY: PM ............................................ TYPE: [N CMECK 8: 0 <br />~ THIS IS NOT A PERMIT. ,TNIS APPLiBATISN MUST FA) THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST BE COMPLETED, IT IS THE RESPONSIBILITY OFTHE APPLICANT TO ASSURE THAT <br /> LL NECESSARY INFORMATION NAS BEEN PROVIDED. <br /> <br />PI. AI,[ REVIEW: BY -,~"' DATE- ~....T__?Z"__?..~__ HEIGHT: ,, SETBACKS: FR...? <br />ZONING: BY ..................... DATE"- TOTAL ,~Q FT: ~,66 Lo ,., <br /> <br /> PLAN, ACTION: RR'"' 5 <br /> ENERGY 'PATH: ? SF'"' <br /> <br />(::['fY ,JURISDICTION." BY ............... DATE ............... <br />REMARKS: M)'£W RES <br /> <br />OFFICE COPY <br /> <br /> <br />