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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG NO 225 <br />220 HIGH STF{EET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br /> CODE-A-PHONE 4::30 PM - 8::00 A,M <br /> <br /> I am performing work on aproperty I own or occupy <br /> I am a registered builder OR I I the authorized representative SIGNATURE OF APPLICANT ~,,,...~ <br /> of 8 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 <br /> this document <br /> <br /> 0ATE: 06/05/8? TINE: 2:52: 12p <br />OWNER TAX LOT <br /> LOHsE, PAUL <br /> <br /> CONSTRUDTION TYPE <br /> <br />R <br /> <br /> 8?84 NILL CREEK RD SE <br />AUNSVILLE OR 9?325 <br /> <br />USE OF BUILD~NG <br /> <br />N <br /> <br />OCCUPANT LOAD <br /> <br /> NO OF BEDROOMS <br /> <br />MAILING ADDRESS SUBDIVISION <br /> <br /> SANE <br /> <br /> PHONE: 749-2815 SITE NUIVtBER.* 1588 <br /> VALUATION: <br /> <br />LOT SLOCK SECTION TOWNSHIP RANGE ZONE <br /> <br />MAP <br /> <br />WIDTH DEPTH AREA UNITS IRRSG LOT CORN~ <br /> N N <br /> <br />TYPE: NECHAN ICAL <br /> <br />CONTRACTOR, NO. <br />LOHSE, PAUL <br />SANE <br /> <br />PHONE: 749-2815 <br /> <br />PERMIT OR APPLICATION NO: <br /> <br /> I TEN <br />[XDNESTIC WOOD STOVE <br />MECHANICAL BASE FEE <br />FLEET SURCHARGE -ZONE 3 <br />MECHANICAL STATE SURCHARGE <br /> <br />PAYEE: LOHSE, PAUL <br />RECEIVED BY: c] <br /> <br />2554 <br /> <br />CUANTITY ANOUNT <br /> 1 <br /> $10-00 <br /> ~3.84 <br /> 0.?0 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$22.04 <br /> $0.00 <br />$22.04 <br /> <br />BALANCE DUE $0.00 <br /> <br />INVOICE NO: 3056 <br />TYPE~ CA CHECK ~ 0 <br /> <br />* THIS IS A VALID P~IT ~ THIS PEI;~I~T EXPIEB' 180. DAY~ FEON ITS ISSUE DATE. IF <br />CONSTRUCTION Cl5~ FOR A PERIODOF 1~0 DAYS, OR IF:"CONSTRUCTION FAILS TO MEET ALL <br />RE(~UIREMENTS OF STATE LANSAND MARION COUNTY BU:I,LDING'AND ZONING ORDINANCES, THIS PERMIT <br />SHALL BECOHE NULL AND VOID. ,, <br /> <br />REMARKS: WS EXISTING ~f~C..~(q <br />DONALD E. WOODLEY, MARION ~NTY 8UILD~NG OFFICIAL / BY <br /> <br />OFFICE COPY <br /> <br /> <br />