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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLOG. NO. 225 <br /> 220 HIGH STREEt- NE/~ <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 P.M, - 8:00 A.M. <br /> <br />I am periorming work on aproperly I owr~ or occupy. <br />I am a registered builder OR ) the authorized representative <br />of a registered builder, <br />The work will be performed by a registered builder, <br />Other. <br /> <br />DATE: 12/11/8@ TI~E:.12~59;15 <br /> OWNER; <br /> CHURCH OF 60D OF PROPHECY <br />SITUS ADDRESS: <br /> <br />TAx LOT: <br /> 61221-000 <br />CONSTRUCTION TYPE; <br /> <br />CATEGORY: <br /> COhT4ERC I AL <br />OCCUPANCY: <br /> <br /> 10637 STAYTON RD SE <br />AUMSVILLE OR g7325 <br /> <br />USE OF BUILDING: <br /> <br /> i dO~TRAS~ OITY: ' UGB: <br />~ION COUN'f~f :: NO <br /> <br />gl6 N BIRCH C/O DENNIS <br />STAYTON, OR. 9?383 <br />~40NE: ?69-5088 <br /> <br />LOT: BLOCK: <br /> <br /> SITE NUMBER-· 2302 <br /> VALUATION ** <br />:S~CTION; fOWNSHIP: RANGE; Z0 N'E'. MAR: <br /> <br /> 17 ! gS ~ N EFU 6 0 <br />: ~Ai i UNITS: IRREG. LOT: CORNER: <br /> 2. AC NO NO <br /> <br />TYPE: MECHANICAL PEF~4IT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. <br />CHURCH OF GOD OF PROPHECY <br />916 N BIRC~ C/O DENNIS Obt.~N <br />STAYTON, OR. 9?383 <br />PHONEs 769-5088 <br /> <br /> ITEM <br />FIR~ DAMPER <br />FORC AIR FURN 100000 B~IJ OR LESS <br /> CON'L EXHAUST SYSTE~ <br /> COM'L HOOD & EXH SYSTEM <br /> MECHANICAL BASE FEE <br /> FLEET ~JRCHARGE -ZONE 3 <br /> MECHANICAL STATE SURCHARGE <br /> <br />PAYEE: CHURCH OF GOD OF PROPHECY <br />RECEIVEO BY: p~ <br /> <br />11235 <br /> <br />QUANTITY AMOUNT <br /> 3 <br /> $24.00 <br /> $13.50 <br /> 1 $4.50 <br /> $10.00 <br /> ~3.84 <br /> 3.05 <br /> <br />TOTALASSE~..~ED FEES <br />PREVIOUSEECEIPTS <br />THISRECEIPT <br /> <br />$67.69 <br /> $0.00 <br />$67.89 <br /> <br />BALANCE DUE $0.00 <br /> <br />RECEIPT NO: 22000 <br />TYPE: CK CHECK ~ 1652 <br /> <br /> THiS IS A VALID PERI'IT ~ THIS PERMIT EYCIEES 180 DAYS FI~M ITS I~E ~TE. IF <br />~TI~ C~ ~R A P~IOD ~ 180 ~, OR IF ~I~ FAI~ ~ ~ ALL <br /> <br />RI~4AR;~: 4 FURN,DANPERS,3ExHTs 8AL DUEECNDFILTER PEt~IT~~'- <br />DONALD E. ~0ODLEY, MARION COJNTY BUILDING OFFICIAL / BY <br /> <br />OFFICE COPY <br /> <br /> <br />