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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 aproperty I own or occupy. <br />( ) <br /> I am a registered builder OR ( ) the author zed epresen a ye S GNATURE OF APPLICANT' <br />{~') Of a registered builder, ' <br /> <br />: owr, tE~i¢!TE." '0~.70~795 T~'HE~.' I:L ........ ~' YAk LOT; {CATEGORY: <br /> <br /> :L445,,~ ~Rl,ID'r ~D~ , fie ~ / <br /> J <br /> <br />,uSs o~ emC6f~'~,. ~o o~ <br /> <br />TYPE: BUILDING PERMIT OR APPLICATIOH <br /> <br />C?ITRAC, TOR, NO., 66187 ARCHITECT/ENGINEER, <br />,Cloyd R Wa'l:/; Cm~struction C <br />FO Box 17277 <br />Portland- 97217-e~ <br />PHONE~, ~85-0333 ..... ,~~ . PHONEt ' <br /> <br />PLAN REVIEW :':: · .... : :: <br />FIRE ~ND L~FE ShFETY ~ ::: <br />gIJ[1.~NG STATE SURCHARG~ <br /> <br />QUANTITY <br /> <br /> PAYE"E: Cloyd R Watt <br /> Rr~CEIVED BY: MB <br /> <br /> * THiS iS NOT A PERMIT. <br />FOLLOWING HUST BE <br /> LL NECESSARY INFORMATIOHi <br /> <br />Pl.,AN F~EVIEW: <br />ZONING: BY <br />SEPTIC: BY .................................... D~TE' <br /> .......................... iET' 7"" '.]" ."-, PL~H.,ACTIOfl: <br />CITY JLIRISD~C'~I8N: BY_ Z~£~ "ENERCY PATH: <br />REHARKS: COI_UHBIA HI~LIcoP/~,RS <br /> <br />AMOWNT <br /> $184..0~ <br /> $119.60 <br /> $73.60 <br /> $9.2~ <br /> <br />$386.40 <br /> $0.00 <br />$~86,,40 <br /> <br /> 6~157 <br />],TYPE: CK CHECK ~: 3957 <br />' REVIEW PROCESS WHERE THE <br /> APPLICANT TO ASSURE THAT <br /> <br />~OTAL SO-Fl='42000 <br />sTORIEg: 1 <br /> <br />SETBACKS: FR <br /> <br /> RR ........... <br /> SP ........... <br /> <br />OFFICE COPY <br /> <br /> <br />