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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG NO 225 <br /> ' 220 H'IGH STREE,T NE <br /> SALEM, O~EGON 97301 <br /> <br />PHONE 588-5147 <br />CODE-A-PHONE430PM -800AM <br /> <br /> ~ I em performing work on a property I own or occupy <br /> '~ I a~'l a registered builder OR ~ ) tho authorized repre~entatrve <br />DATE~ a O~j.C~./~er T I ME' 8-· 35: 4 ga <br /> } me won~ w ~ me performed by a reg~EterecFburlder <br /> Oth <br /> ,/ ~ h~Jr~&~ a~fto tho terms stated on tho reverse s~do of <br /> <br />DAg'~040--510 <br /> <br />RESIDENTIAL <br /> <br />OWNEn 850 8TH <br />AUMSV I LLE <br />SITUS ADDRESS <br /> <br />OR 97325 <br /> <br />TYPE <br /> <br />YES <br /> <br />CATFG©R¢ <br /> <br />OCCUPANCY <br /> <br />CONTRACT CIT~ <br /> <br /> UGB <br /> <br />DEL MAR I I I <br /> <br />OCCUPANT LOAD <br /> <br /> NO OF 8EUHOOMS <br /> <br />suBm~m~$TE NUf'4BER¢ <br /> VALUATION: <br /> <br />6748 <br /> <br /> 10 6 <br /> <br /> ?5 <br />I OT 8LOCK <br /> <br />CONTRACTOR. NO. 28638 <br />T G.NICHOL PLUIV~ING. INC <br /> <br />PHONEt 749-2071 <br /> <br />RESiD~AL FIXTURE, NEW CONST. <br />PLUMBING BASE FEE <br />FLEET SURCHARGE ,-ZONE 3 <br />PLUMBING STATE SURCHARGE <br /> <br /> 25 8S <br /> <br />95 7125.00 SF <br /> SECT[ON TOWNSHIP RANGE <br /> <br />PERMIT OR APPLICATION NO: 9014593 <br /> <br />2W RRS <br /> <br /> NO NO <br /> ZONE MAP <br /> <br />TOTAL ASSESSED FEES <br /> <br />BALANCE DUE <br /> <br />QUANTITY <br /> 6 <br /> <br />AMOUNT <br /> <br /> $3.70 <br /> <br /> $81,54 <br /> $0+00 <br /> $81.54 <br /> <br /> $0-00 <br /> <br />PAYEE: ]".~,~N=i~¢L F~Ui~ZiNG. [i',~. INVOICE NO: 1547~ <br />RECEIVED BY: pr TYPE: IN CHECK ~: <br /> <br />~ THIS IS NOT A PERMIT. THIS APPLICATION MUST GO THROUGH A REVIEW PROCEE~.$ ~HERE THE <br />FOLLOWING MUST BE COMPLETED+ IT IS THE RESPONSIBILITY OF THE APPLICANT TO ~RE THAT <br />ALL NECESSARY INFORMATION HA~ BEEN PROVIDED. <br /> <br />PLAN REVIEW: BY DATE CITY JURISDICTION: BY DATE <br />REiV~ARKS; 6-NEW FIXTURES <br /> <br />REv 11'~8 OFFICE COPY <br /> <br /> <br />