|
MARION COUNTY BUILDING INSPECTION
<br />SENATOR f~LDG, ~D, 225
<br />~2.~X) I-J&GH STREET NE
<br /> SALEM, OREGON 97801
<br />
<br /> PHONE 588-5147
<br />CODE-A-PHONE 4:30 RM. - 8:00 A,M.
<br />
<br />I am performing work on a property I own or occupy.
<br />I 8m 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 />TAX LOT: CATEGORY:
<br />
<br /> , ! B¢-.SI DENTIAL
<br />CONSTRUCTION TYPE: OCCUPANCY:
<br />
<br /> 11808 11848 Db'CK,INN ROAD ¢~ NE
<br />GERVAIS OR 9?026 ~, ~;
<br />
<br />,, .MARION COUNTY NO NO. OF BEDROO~S,
<br />
<br />SUBDIVISION:
<br />
<br /> , 1.1848 BUCK INN RD NE =,
<br /> G'ERVAI~. OREGON 9702,6
<br /> PHONE,~,"?'92-4259
<br />LOT' ~LOCK:
<br />
<br />SECTION:
<br />
<br />'~, ,"i SITE NUNBER: 4643 ,'.,*~
<br /> ~/ALUATION: ~, ,~
<br /> TOWNSHIP: RAnG : ZONE: MAP'.
<br />
<br />WlC fH: DEPTH:
<br />
<br />: AR~Ai=,=;'% :,'!i~:~'=h ;::uNJYs: :¢ ~;S ' IRR~ LO~r~ ~)~/~ CORN~H: EFU 18
<br /> ,;: ,,. ;~:,~28 ;~00O O AC NO NO ,,
<br />
<br />TYPE:. PLUMBIN~
<br />
<br />PE~IT OR APPLICATION NO= 14682
<br />
<br />COf4TRAOTOR, ~0~
<br />MARTIN, KIM & DtA~E~
<br />11848 DUOK:[NN RD NE
<br />GEFA/A~$, OREGON 97026
<br />~E, 792~259
<br />
<br /> ITEM
<br />HATER ..LTuNES, 1ST 100 FEET
<br />SEt~ER LINES, 1ST 100 FEET
<br />f40SILE HOME SE'WER,.N~D,HATERC(~INECTION,k,~,:~,
<br />FLEET SURCHARGE -Z~E 4 ',',',
<br />P~ING STATE ~
<br />
<br />~EE:
<br /> I.VE~ ,BY.*
<br /> IS A VALID
<br />
<br />SHALL 8E~ NULL
<br />
<br />TOTAL A~E~.~ED FEES
<br />PREVIOt.~ PJECEIPTS
<br />TI~IS~RECEIPT
<br />
<br />BALANCE EXJE
<br />
<br />OUANTITY ~4OUNT
<br />3 $60~00
<br />~ $30.00
<br />
<br /> $5.12
<br />
<br /> . RECEIPT NO:,,
<br />TyPE~: .... CHECK ~:
<br />
<br />DONALD, E. NOODLEY,~,MARION C~JNTY BtJ[LDING OFF~CI'AL
<br />
<br />$125.87
<br />$125.87
<br /> $0.00
<br />
<br />$0..00
<br />
<br />FORMpMC16-~56 REV 11~8 OFFICE COPY
<br />
<br />
<br />
|