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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 e. property I own or occupy. <br />I am a registered buiider OR the authorized representative <br />of a registered builder. <br /> <br />Other = : <br />The work wlJ[ be performed by a registered builder.· <br /> <br />t have read and agree to the terms stated On the reverse side of <br />this document, <br /> <br /> .~-N ' H 1 ' ' <br /> ;~(55 SANTIAI~ -.- ~¢~= ........ T-o-~? ............... ~0~-~--Eb~Si ......... ~ <br /> DETEO~T OR 77~42 ~ DETROIT NO <br /> <br />b~'~" ~ ~-8~i~6f~ .............. ~67-~' '~5~bo M~ ' <br /> RESIDENTIAL ACCESSORY STRUCTURES <br /> <br />MAILIN~- ADDRESS; <br /> <br />P.O. BOX 592 <br />~EI'ROIT OR ~7342 <br />PHONE: 854-3453 <br /> <br />SU 8OIVISIOS <br /> <br /> HAMMOND <br /> <br />SITE NUMBER: ~-~3884 <br />VALUATION: $1&~565.55 <br /> <br /> 5055. NO <br /> <br />TYPE: BUILDING PERMIT OR APPLICATION NO: 9~51259 <br /> <br /> 105 .......... <br /> <br />NO ~ <br /> <br />CONTRACTOR~ [~0. 62~28 <br /> <br />3884 Buena Vis'~a Rd <br />Jefferson~ 77352-0000 <br />PHONE: 3~2-2758 <br /> <br /> ITEM <br />BUILDING FEE <br />PLAN REVIEW <br />BUILDING STATE SURCNA~G <br /> <br />ARCHITECT/ENGINEER~ NO. <br /> <br />QUANTi[TY <br /> <br /> PAYEE: Da~ <br /> RECEIVER BY: PM2 <br /> <br /> ~ THIS IS <br />FOLLOWING MUST BE <br /> LL NECESSARY INFORMATI= <br /> <br />AHOLJNT <br /> $122.50 <br /> $79.6~ <br /> <br />$208.26 <br /> $0.50 <br />$208.26 <br /> <br />$0.00 <br /> <br />TYPE: IN CHECK <br /> <br />REVIEW PROCESS WHERE THE <br /> APPLICANT TO ASSURE THAT <br /> <br />PLAN REVIEW: BY <br />ZONING: BY _ <br />SEPTIC: BY ......... <br />CITY JURISDICTION: BY ~A~~/~'=~m" PATH: <br />REMARK~ GARAGE <br /> <br /> SETBACKS: FR._20 <br />11154 LS 5 <br /> RS'-5 <br /> RR'"15 <br /> <br />~o~,,~ MC ~s.~,~'. ~,~ OFFICE COPY <br /> <br /> <br />