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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG. J~O. <br /> 220 HIGH STF~EET 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 8 property I own 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 /> I have read and agree to the terms stated on the reverse side of <br /> this document. <br /> <br /> DATE: 10/01/9] '¥J, lvlE:17:45:00 <br />OWNER: <br /> 'f'OUVlAN, JOANNE <br /> <br />SITUS ADDRESS: <br /> <br /> 175 DEl'ROi I AVE <br />DE]ROI i OR 9?342 <br /> <br />:USE OF BUILDING: <br /> <br />SIGNATURE OF APPLICANT' <br /> DATE: <br /> <br /> T~ LOT. <br /> <br /> OONSTRUCTION TYPE <br /> <br /> CONTRACT OlTY; <br /> <br /> '3El'R01'1' <br /> <br />RES[ 0EN'f <br /> <br /> OCCUPANCY· <br />UGg: iOCCURANT ~OAD' <br /> ,NO 0P 8£OR00M$ <br /> <br />MAILING ADDRESS: SUBDIVISION: <br /> H~D ADDII'ION LOTS 8,'?,8 <br /> <br />F'%) BOX 582 <br />DETROIT OR 9'?S42 <br />P'Hr,)'NE: 854-3?6? SiT'E NUM~N: 235? <br /> VALUA'r;ON: <br /> <br /> I Ol 10 5b <br /> CORNE: <br /> <br /> 'fYPE: t'4ECHANiCAL PEk'MtT OR APPLJ, CAf'fON NO: 35817 <br /> <br />( FO~ AiR FURN 10~000 BTU OR L¢~ I/p-- ~ ~ $6.00 <br />~NIGAL ~¢FEE , , J-/ $10.00 <br /> <br /> f'OTAL ~E~BD FEES $16,80 <br /> PR6W ~S RECE t P'f'S ~ 18.38 <br /> <br /> BAL~CE ~E $0,00 <br /> <br /> PAYEE: 'FO~N, JO~NE ~NVOICE NO: <br /> RECEIVED BY: ~2 TY~E: ~N ~ECK ~: 0 <br /> <br /> ~ST~OTI~ O~ FOR A PER/OB OF 180 ~Y~; OR.:IF ~aT~OT~ FA~ TO ~EET ALL <br /> R~IR~TS OF STATE ~ ~D ~RI~ ~N~:BU~LDiN6 ~B Z~iN60ROIN~OES. THiS ~IT <br /> ~ALL BEdE NULL ~D VOID. <br /> <br />REMARKS: EXISTING FURNACE <br /> <br />DONALD E. NOOOLBY, MARION COUNTY BUILDING OF'FtCIAL / BY <br /> <br />FORM # MC 1§-§~ RE~v', 4/'90 OFFICE COPY <br /> <br /> <br />