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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG NO, 2:'5 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4 80 PM.. - 8 00 AM <br /> <br />I am performit~g work on a property I own or occupy <br />I am a registered builder OR k ) the authorized reprosontatwe <br />of a registered builder <br />The work wrfl be performed by a registered builder <br />Other ,, <br />I have resd and agree to the terms Ststed on the reverse s~de of <br />this document <br /> <br />oM;LA~TE: 05/17/89 <br /> BORAN, TON <br /> <br />TIME: 2:08=36p <br /> <br />90040-240 <br /> <br />RESIDENTIA[ <br /> <br /> 840 9TH ST <br /> AUMSVI LLE <br />USE OF BUILDING <br /> <br />OR 9?925 <br /> <br />AUMSVILLE NO <br /> <br />MAILING ADDRESS <br /> <br /> P.O. BOX 185 <br /> SUBLIMITY, OR 9?385 <br /> PHONE: 759-7364 <br /> <br />LOT BLOCK <br /> <br />SECTION TOWNSHIP <br /> <br /> DEL NAR I I I <br /> <br />SITE NUMBER: 7206 <br />RAN~ALUATION ~ zo.s <br /> <br />MAP <br /> <br />75 100 <br /> <br />2W CO,N~M I:~ <br />NO NO <br /> <br />51 <br /> <br />TYPE: MECHANICAL PERC4IT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. 55493 <br />TON EX)RAN <br />PO 8OX 185 <br />SUBLIMITY 97385 <br />PHONE~ 769-7364 <br /> <br /> ITEM <br />DOMESTIC RANGE HOOD <br />BOM EXHST FANS & DRYER VENTS <br />MECHANICAL SASE FEE <br />FLEET ,SURCHARGE -ZONE 3 <br />MECHANICAL STATE SURCHARGE <br /> <br />PAYEE: <br />RECEIVED <br /> <br />15795 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY AMOUNT <br />1 $4.50 <br />3 $9.00 <br /> $10.00 <br /> ~3.84 <br /> 1.18 <br /> <br />$28.52 <br /> 25.37 <br /> $3.~5 <br /> <br />8AL4J'4CE DUE $0.00 <br /> <br /> INVOICE NO: 17043 <br />TYPE~ CHECK ~= <br /> <br />THIS I$ A VALID PERNIT * ,: T~t$:::PERMtT~ ED(PiRS~)i80 ~ F~ ITS I~E ~TE. IF <br />~T~TI~ ~ ~R A ~R~:~ ~80,~. OR IF ~MC~I$ FAi~ TO ME~ A~ <br />~LL 8E~ NULL ~O ~O~ :. ,, <br /> <br />RENARKS: 1 UTILITY FAN, DRYER. 8ATHROO~ <br /> <br />DONALD E. ~E)ODLEY, NARION COUNTY BUILDING OFFICIAL / BY <br /> <br />FORM ¢ MC lS,u6 ~ ,IFS~ OFFICE COPY <br /> <br /> <br />