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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 performing work on a property I own or croupy. ~ <br />I am a registered builder OR the authorized representative SIGNATURE OF APPL~CAN <br /> of a registered builder, ' <br />The work will be performed by a registered builder. <br />Othe~ <br />I have read and agree to the terms stated on the reverse side of DATE~ <br />this document. <br /> <br />WELLS~ JEFFERY <br /> <br /> 12~73 WEST STAYTON R~ SE <br /> AU~SVZLLE OR ~7~2~ MARION COUNTY NO~ ' <br /> <br /> ~uENTIAL ACCESSORY STRUCTURES <br /> <br /> PHONE: 769-7386 ~ ~ VALUATION: $9~ 736. <br /> <br />TYPE: BUILDING <br /> <br />CONTRACTOR~ NO. <br />WELLS, JEFFERY <br />SAME <br /> <br />PERNIT OR APPLICATION NO~ ~B48553 <br /> <br /> ARCHITECT/ENGINEER, NO. <br /> <br />PHONE: 7~?-7~B6 PHONE: <br /> <br /> ITEM <br />BUILDING FEE <br />PLAN REVIEW <br />BUILDING STATE SURCHARGE <br />ZONIliG SURCHARGE <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT-' <br />BALANCE BO~. <br /> <br />QUANTITY <br /> <br />AMOUNT <br /> $8e.50 <br /> <br /> $4.0~ <br /> $4..8~ <br /> <br />$140.8~ <br /> $8.88 <br />$140.8~ <br /> <br />$0.00 <br /> <br /> PAYEe: WELLS~ JE~FERY,-~'~. ' ~08&8 <br /> <br /> .......... ::-:=:= ........ ....... <br /> * THIS IS NOT a PERBIT~".' THIS;AP~[i- ........ ~ ~E~IEN PROCESS ~N£RE THE <br />FOLLONIHG BUST BE COBPLETEB,.'IT THE APPLICAHT TO ASSURE THAT <br /> LL NECESSARY , <br /> <br /> PLAN REVIEW: BY ATE %~ GH SETBACKS: FR <br /> ZONING: BY .~- '-~--- BATE ~]}~--- TOTAL ~Q FT: 728 <br /> STORIES: 1 <br /> PLAN.ACTION: RRT~Z <br /> CITY JURISDICTION: BY' BATE ENERGY PATH: SP <br /> REMARKS: GARAGE AND ROOF ALTERATION <br /> <br />~oaa # ~c ~s.se aEV. 4~ OFFICE COPY <br /> <br /> <br />