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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 />I I am performing 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 />( ) I have read and agree to the terms stated on the reverse side of BATE; <br /> this document. <br /> <br />OWNER'. , <br /> BOOZE., KENNETH & JUDITH ; 40287-000~-~'r~ RE.~IDENI'~AL <br /> <br /> 10207 NATTHIEU [aNE NE ?'~TRACT CITY: , UGB OCCUPANT LOA~: <br /> <br /> aUROR~ ' OR ~7002 ~ HARMON COUNTY.~ NO <br /> <br /> DNELLlN68 4 <br /> ~ SUBDIVISION: <br /> <br /> ', SITE NUHBER= <br /> PHONE= VALUATION: $126~ ~8, ~ <br /> <br />~'~'~ [DEPTH: ~ AREA: I UNIT~: ~ IRREG. LOT; ~CORNER: , <br /> <br />TYPE: DWELLING PERMIT OR APPLICATION <br /> <br />¢ONTRACTOR, NO. 36482 <br /> Wand Nelmo~ ODd,rat(ors <br />PO Box 780 <br />Wilsonville, 97070-0000 <br />PHONE: 682-0377 <br /> <br /> ITEM <br />DWELLING BUILDING FEE <br />DWELLING PLUMBING <br />BWELLING NECHANICAL <br />DWELLING ELECTRICAL <br />DWELLING STATE SURCHARGE <br />DWELLINQ PLAN REVIEW <br />DWELLING ZONING SURCNARGE <br /> <br />PAYEE: WAND-NELSON <br />RECEIVE~ BY: cZ <br /> <br /> 91148695 DP <br />ARCHITECT/ENGINEER~ NO. <br /> <br />PHONE: <br /> <br /> QUANTITY <br /> <br />TOTAL ASSESSED FEES <br />.PREV, IOUS,RECEIPTS <br />~HI$ RECEIPT . <br /> <br />BALANCE.DUE <br /> <br /> TYPE: OK <br /> <br /> AMOUNT <br /> $488.81 <br /> $178.24 <br /> $44.4~. <br /> $139.18 <br /> $42.5~ <br /> $185.8~ <br /> $15.00 <br /> <br /> $i,0~.17 <br /> $0.00 <br /> $1,0~3.17 <br /> <br /> $0.00 <br />51815 <br />CHEOK ~: 4442 <br /> <br /> THIS IS NOT A PERHIT.," 'TH[S' AI:~FfL-ICAT~ON!NU~"I: ~ THROUGH A REVIEN PROCESS WHERE THE <br />FOLLOWING MUST BE COHPLETED.' IT IS~THE ,R~PONSIDILITY OF THE APPLICANT TO ASSURE THAT <br /> <br />LL NECESSARY INFORNATION HAS BEEN PROV~Eg. <br /> <br />CITY JURISDICTION: BY DATE ........... <br />REMARKS: DP/AU:FLD NOED~PF-- <br /> <br />HEIGHT-~ SETBACKS: FR <br />TOTAl_ ~Q FT: ~0~8 LS <br />STORIES: 1 RS--~'~ <br />PLAN. ACTION: RR~.~ <br />ENERGY PATH: SP .......... <br /> <br />~oR~,~ uc ~-,~ R~V, 4/~0 OFFICE COPY <br /> <br /> <br />