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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 5~8-5147 <br /> CODE-A-PHONE 4:30 P.M, -8:00 A,M. <br /> <br /> I am performin9 work on a property I own or occupy. <br /> I am a registered builder OR ( ) the authorized representative S~GNATURE OF APPLICANT: <br /> Of a registered builder. <br /> The work w~ll be performed by a registered builder. <br /> Other <br /> ~ have read and agree to the terms stated on the reverse side of DATE'. <br /> <br />DATE~ 11/12/87 TIME: 10:11:43a <br /> <br />AUNSV~ LLE OR 9?325 <br /> FAIR CAKES ESTATES <br /> <br />~ BOX 719 <br />AUFC3VILLE <br />PHONE: 749-.1959 <br /> <br /> 13 <br />wIDtH: ;DEPTH: <br /> <br /> SITE NUIV[SER: 2752 <br /> VALUATION: <br /> <br />AREA UN TS' : RREG LOT CDR <br /> <br />TYPE: MECHANICAL PE~4IT OR APPLICATION NO: <br /> <br />CONTRACTOR. NO. 48630 <br />WILLIAMETTE I,'¢E~)O STOVES <br />3195 LIBERTY RD S <br />SALEM, OREGON 9?309 <br />PHONE: 370--7288 <br /> <br /> ITEM <br />DOMESTIC MOOD STOVE <br />MECHANICAL BASE FEE <br />FLEET SURCHARGE -ZONE 3 <br />N!ECHANICAL STATE SURCHARGE <br /> <br />PAYEE: WILLIANET'TE WOOD ~'FOVE3 <br />RECEIVED BY: DH <br /> <br />5477 <br /> <br />QUANTITY AHOUNT <br /> 1 $?.50 <br /> $I0.00 <br /> $3_84 <br /> $0.88 <br /> <br />TOTALA,B,SI SS D <br />PREvzous: ¢ I Zs <br /> <br />$22.22 <br /> $0.00 <br />$22.22 <br /> <br />$o. OD <br /> <br />INVOICE NO; 6043 <br />~YPE: I~ CHECK ~: 0 <br /> <br />~ THIS IS A VALID PERt4IT * THIS ,PERMI~.~iRES 180 DAYS FROM ITS ISSUE DATE. IF <br />CONs~rRLICTI~ C~ES FOR A pERIOD OF'71'80::'D~'¥'S~'~;-OR,'~E.,,~TRUCTION FAI~ TO MEET ALL <br />RE(~IRENENTS OF STATE L.N~J~D ~IARION ~N~ BUILDING,'~D Z~ING ORD[~C~. ~IS ~IT <br />~LL BE~ NULL ~D~ID. <br /> <br />RE~RKS: ~ <br /> <br />DONALD E. ~OODLEY, ~ARION COUNTY BUILDING'OFFICIAL / BY <br /> <br />FORM '¢ MC, 1!~.5~i ~EV 6/87 OFFICE COPY <br /> <br /> <br />