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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, ~5 <br />2~0 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 builder, <br /> <br />Of her_ <br /> <br /> I have read and agree to the terms stated on the reverse side of <br /> <br /> DATE: 11/12/37 TIME: 3:14:37p <br /> <br /> MANRIGUEZ, CLEO <br /> <br />' ~iTUS ADDRESs; <br /> <br /> 2!0 KLEIN <br />.AUF~SV f LLE OR <br /> <br />TAX LO~i { ~A+EGORY: <br />CONTRACT CITY; ! UOB; i~C~U~ANT LOAD: <br /> <br /> ALIHSVILLE ~ NO I <br />USE OF BUILDING: :N0 0¢ 6EDR00MS: <br /> <br /> INDUST'BIAL 8U I LDINGS <br />MAlt, lNG ADDRESS: I SUBDIVIBION; <br /> <br /> ~) SOX 394 <br /> AU~V~LLE, O~ 9?325 <br /> ~ONE: ?49-2462 : SITE NUMBER: 30?3 <br /> VALUAT l ON <br /> <br /> ' ~ I RANGE: <br />LOT: BLOCK: i SECTION: ~ ~'~ S ~ i P'. ' ~ ZONE: <br /> <br />WIDTH: ~DEPTH: : ASEA: ~UNITS: ~ IRREG, LOT: NO <br /> <br />:: ~PE: :N~AN[CAL PE~[T OR,APPL[CAT[~ NO= 549? <br /> <br />CONTRACTOR, NO_ <br />MANRIGUEZ, CLEO <br />PO BOX 394 <br />AUMSVILLE, ORE 9?325 <br />FsHONEt ?49-2452 <br /> <br /> ITEM <br />DOMESTIC WOOD STOVE <br />MECHanICAL BASE FEE <br />FLEET SURCHARGE -ZONE 3 <br />MECHANICAL STATE SURCHARGE <br /> <br />:TOTAL ASSF~EDEEES <br />; :~REV[OUS:REGEZ~TS <br /> <br />0UANTITY AMOUNT <br /> 1 $7.50 <br /> $10.00 <br /> $3.84 <br /> $0.88 <br /> <br />$22.22 <br /> $o,oo <br />$~,.2-2~ <br /> <br /> TH;IS ;RECEIPT <br /> <br /> A,Y. EE MANR C UEZ. CLEO ': INV,O. CE NO <br />RECEIVED BY: DM ~ :' TYPE: IN ~'CHECK <br /> <br /> ~IS IS A VALID PE~IT ='~IS P~IT ~IR~ 180 F~ ITS <br />~CTI~ C~ ~R A P~OD FAI~ TO ~ ALL <br />R~[R~TS OF STATE ~;=~D ~I~ ~ 8MILDI~;.~D Z~IN60RDI~ <br />~ 8~E NULL ~B ~ID. ' <br /> <br />R~RKs: ~S' <br /> <br />~J'NALD E. NOODLEY, MARIOJW COUNTY SU;[LDINS' 0F~['CI~L / BY <br /> <br />FORM ~r MC 1 ~'5~ REV ~/~7 OFFICE COPY <br /> <br /> <br />