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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, 225 <br />220 HIGH STREE-¥ NE <br /> SALEM, OREfGON 97301 <br /> <br /> PHONE 558-5147 <br /> CODE-A-PHONE 4;30 P.M. - 8:00 A.M. <br /> <br />I am performing work on a property I Owr~ of' OCCUpy. <br />~am 8registoredbullderOR( ) the authorized representative <br />of 8 registered builder, <br />The work will be performed by a registered builder. <br />Other. <br /> <br /> r have read and agree to the terms stated on the reverse side of <br /> this docur~onL <br /> <br /> C~A-r E:: 06/21/88 T ir¢lE: 3:38: 14, p <br />OWNER: <br /> EVERETT, LOLA <br /> <br />557 MC CL. ELLAN RD SE <br /> <br /> CONSTRUCTION TYPE: i OCCUPANCY: <br /> <br />CONTRACT CITY; i UGh: ;OCCUPANT LOAC; <br />~ARZON COUNTY NO ' <br /> <br />S852 _;TTLE ROAD <br />Ajv,,.W~ L. 9?325 <br />oHONE; 749--~aa'7 <br /> <br />BLOCK: <br /> <br /> SITE NU~4BER*. 47'13 <br /> VALUAT I ON: <br />SECTION; +C~wN~iP: .....................................: RANGE: 'i ..................... ZONE: iMAP: <br /> <br /> , NO NO <br /> <br />T'YgE: ~,'I,,CHAN ,L,A~, PERr,4IT OR APPLICATION NO: <br /> <br />9249 <br /> <br />CONTRACTOR. NO. <br />~:V,iRc, Tz L.OL_A <br />8852 i_I ['TLE ROAD SE <br />AUIvlSV I LLE 9?325 <br />aHON E; ?49~ 1447 <br /> <br /> Z TE~' <br />DOHES"rZC WOOD STOVE <br />~IECHAN;CAL BASE FEE <br />FLEET SURCHARGE ~ZONE 3 <br />';!ECHANZCAL STATE SURCHARGE <br /> <br />QUANT I TY AJ'flOUNT <br /> ! $? <br /> $ ~ 0. O 0 <br /> $3_84 <br /> SO,SS <br /> <br />TOTAL ASSESSEDFEES <br />~REW;OUS RECEZBTS <br />THIS RECEIPT <br /> <br />$22.~2 <br /> $0.0C <br />$22.22 <br /> <br />BALANCE DUE $0. CO <br /> <br />PAYEE: EVERETT, LOL~ R~CE~P'T NO: 99]8 <br /> <br />* THIS IS A VALID PERNIT * THIS PEF;C4IT EXPIRES 1BO:DAYS FRON::iTS ISSUE DATE. IF <br />CONSTRUCTION CEASES FOR A PERIOD OF 180 DAYS, OR IF CONSTRUCTION FALLS TO ~EET ALL <br />REQUIREMENTS OP STATE LANSANB I',IARION COUNTY BUILBIN~ANB ZONING ORBINANOF-.~. THIS PERNIT <br />SHALL BECONE NULL AND VOID. <br /> <br />REIvr.A. RKS; EXISTING WS R~t??23 <br /> <br />.... ~IA,,,~, ¢,(.,U~A_,.=.Y, ~ARION COUN~'Y BUILDING )FF;CIAL //BY <br /> <br />FORM It MC 15-2(i F4kV S/~r OFFICE COPY <br /> <br /> <br />