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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-PRONE: 588-7904 ~,~.~_, tr'/~_~- L __~___~-~ <br />I Sm e regietered builder OR the authorized representative SIGNATURE OF APPLICANT:,~.,~, ~,. <br />of a ~eglste~ed bUitder, <br />The work will be pedormed by a registered builder. <br />Other. <br /> <br />this document, <br /> <br /> CgBB~ RIClt~RD RESIDENTIAL <br /> <br /> 5-N M'-I <br /> ,11698 WARBLER LANE NE CONT~I~f~ ....... <br /> AURORA OR ?7882 MARIOM COUNTY[ NO <br /> <br /> j~ CENTURY MEADOWS ~4 <br /> $52~ ~APLE STREET ~ <br /> HUBBAR~ 97~2 DAYTIME 684-42D~ SUE ~ SITE NUHBER: <br /> PHONE= 981-8168 ~ VALUATION: <br /> <br />LOT; ~Bg0C '. ~ SECTION'. ~ TOWNSHIP; ~ ~ANGE; ~Z0 ; tM : <br /> 68 87 522~. SF ] NO NO <br /> <br />TYPE= BUILDIN6 PERHIT OR APPLICATION NO: ~18513&4 <br /> <br />CONTRACTOR~ NO. 5~271 <br /> DANS MOBILE HOME SERVICE <br />PO BOX :[181 <br />WQOBBURN~ 77071 <br />PNONE: 26~-52~2 <br /> <br /> ARCHITECT/ENGINEER, NO, <br />..... :-.-..PHQNE,:..~ <br /> <br /> ITEM <br />BUiLdING FEE <br />PLAN REVIEW <br />BUILDING ~TATE SURCHAAGE <br />ZONING SURCHARGE <br /> <br /> gUANTITY AMOUNT <br /> $58.58 <br /> <br /> $2.53 <br /> <br /> $88.39 <br /> $8.00 <br /> ~88.37 <br /> <br /> $0.00 <br /> <br />TYPE: CE CHECK ~: 4?5 <br /> <br /> REVIEW PROCESS WHERE THE <br /> APPLICANT TO ASSU~E THAT <br /> <br />PAYEE: RICMARD/SUE <br />RECEIVED BY: PM <br /> <br /> · THIS IS HOT A PERMI? <br />FOLLOWIN~ HUST BE <br /> LL NECESSARY INFORHATI~ <br /> <br />rs,,: <br /> <br />PLAN REVIEW: BY <br />ZONING: BY <br />SEPTIC: BY .......................................... <br /> <br />CITY JURISDICTION: BY~,:~,.~,~,,~<,:,,~.,~E:: <br />REMARKS~ CARPORT ................. <br /> <br />PLAN. ACTION: <br />:NERGY, RA[H~ <br /> <br /> SE';'BACK8~, FR ! ,~, <br />480 L.S--,~- <br /> <br />FORM # MC 15-5~ REV, 4/90 OFFICE COPY <br /> <br /> <br />