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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLt)G, 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 /> ~ ~tm ~ eg'ste ed builder OR ( ) the authorized represent~itive SIGNATURE O~ APPLICANT:._~___.~_ _~.~'' ~, ~ ..~ ._~.~ <br /> The work will be performed by a registered builder, <br /> <br /> DATE: ~7/19/9~ TIME: <br /> <br /> 7771 TERRANOE LN <br /> <br /> . ~ TERRENCE <br /> <br /> ~%./ ~ SITE NUflBER~ ~3-~2471 <br /> PHON~: 749-2848 ~ ~ ~ VALUATION: $7~776.88 <br /> <br />TYPE= <br /> <br />CONTRACTOR, NO. <br />PALMER~ CURTIS <br />SAME <br /> <br />PERMIT OR APPL[CATIOH MO= <br /> <br />ARCHITECT/ENGrNEER~ NO. <br /> <br />PHONE: 749-2848 PHONE: <br /> <br /> ITEM <br />BUILDING FEE <br />PLAN REVIEW <br />BUILDING STATE SURCHARGE <br />ZONING SURCHARGE <br /> <br />PAYEE. PAl_HER. CURTIS <br />RECEIVED BY: CL <br /> <br />QUANTITY <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS: <br />THIS RECE'IP] <br /> <br />'BALANCE DUE <br /> <br />AMOUNT <br /> $68.50 <br /> $44.53 <br /> $3.43 <br /> <br />$8.88 <br /> <br />50821 <br /> <br />............................ TYPE: CK CHECK ~: ;~477 <br />LL HECESSARY INFORHATION HAS 'Be'EH PROVTI)EI). ' ~T <br /> <br />PLAN REVIEW: ~Y ~_ DATEJ~-~;~-...~. ~. HEIGHT, 14 <br />ZONING: BY~"'~ ...... BATE ~T,~¢_~,~ TOTAL SOFT: <br /> <br /> PLAN~AOTrON: <br />gl'fY JURISDICTION: BY ......... BATE ......... ENERGY PATH: <br />RE"MARKS: RES/AC~ POLE BLDG /**WAVIEB BOUBLE FEE (CHERYL) <br /> revision plans & calcm <br /> <br />864 <br /> <br />SETBACKS: FR ~ <br /> $*oeed <br /> <br />~O~M ~ ~C t S-S~ R~V. ~o OFFICE COPY <br /> <br /> <br />