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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 226 <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 /> of a registered buUder, <br /> The wo'rk will be performed by a registered builder· <br /> <br />DATE-* 09/11/87 <br /> <br /> BATES. FAY <br /> <br />Sl'f US ADDRESS: <br /> <br />TIME: :31:52p <br /> <br />CATEGORY: <br /> <br />OCCUPANCY; <br /> <br /> 9694 MILL CREEK ROAD SE <br /> ' i ' <br /> AUIVISVILL£ OR 97325 ~W).RION COUNTY NO <br /> <br />MAILING ADDRESS: ~ SUBDIVISION; <br /> <br /> ~E <br /> <br /> ~E; '/49-2840 i SITE NUb,ER;.. 2492 <br /> ~ ' VA~AT ~,t <br /> <br />T,YPE,: 'MEC~:ICAL. ,,PERNIT OR APpLiCATION :::NO,: 4296 <br /> <br />CONTRACTOR, NO. 49050 <br />KEITH LEIBSIv[N~ <br /> <br />FI'tONE: 995-6151 <br /> <br /> ITEN <br />DONBSTIC HOOD STOVE <br />MECHANICAL BASE FEE <br />FLEET SURCHARGE -ZONE 3 <br />MECHANICAL STATE SURCHARGE <br /> <br /> QUANTITY .~'~OUNT <br /> 1 $7.50 <br /> $10.00 <br /> <br /> $o.86 <br /> <br />,TOTAL A~SE~SED;FEES <br />= .P~OUS':RECEiPTS $0.00 <br />::: ~IS';RECEIPT , <br /> <br />~ 8A!JINCE B~E $0.00 <br />PAYEE.' KEITH LEEEC*IAN ~, , ,, ~ :*RECEIPT NO: 4857 <br />RECEIVED BY: DN ~ ~-~ 'rJYpE::,CK?!CHECK :¢i:: 1618 <br /> <br />* THIS IS A YALID PE;RMIT * i :THIs ',~T, EXPIR~, 180 ,'~$..FR~,: I._TS ISE~JE DATE., IF <br />CGI~CTIBN CE~ FOR A FAILS TO ~ ALL <br /> <br /> NULL .,M~lO VOID~ <br /> <br />DONALD E. NOODLEY, MARION COUNTY BUILDING' OFF~.CIAL /:BY <br /> <br /> <br />