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MARION COUNTY BUILDING INSPECTION <br />SENATOR 6LDG NO 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-~-PHOi~E 4::30 PM, - 8;00 AM <br /> <br />I am performm9 work on a property I own or occupy <br />I am a registered builder OR ( } the authorized representative <br />of 8 registered builder <br />The ¢~ork will be 12erformed by a registered budder <br />Other <br /> <br />I have read and agree to the term8 Stated on the reverse side of <br />this document <br /> <br />SIGNATURE OF APPLICANT <br /> <br />°w~,~TE: 05/10/89 <br />srlug AouR~s0ORAN, TOM <br /> <br />TIME: 9:49:33a <br /> <br />900,4,0-050 <br /> <br />RES I DEHT I AL <br /> <br /> CONTRACT CITY <br /> 895 gTH ST <br />AUMSVILLE OR 9?325 <br />USEOFeUILDING AUMSVILLE <br /> <br />UGB <br /> <br />NO <br /> <br />OCCUPANT LO,~D <br /> <br /> NO OF BEDROOMS <br /> <br />P.O. BOX 185 <br />SUBLIMITY. OR 97385 <br />PHONE: 769-7364 <br /> <br />W~DTH DEPTH <br /> <br />?4 <br /> <br /> TOWNSHIP <br /> <br /> ARE^ 28 UNITS 8S <br />105 7770.00 SF <br /> <br />SITE NUMBER'. ?20? <br />R~,NGNtALUATION: ZONE <br /> <br />IRREG LOT 2 ~,,J GOF~NER ~ <br /> NO NO <br /> <br />TYPE; MECHANICAL PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. 55493 <br />TOM DORAN <br />PO 80X 185 <br />,SUBLIMITY 97385 <br />PHONE; ?69-?364 <br /> <br /> ITEM <br />DOMESTIC RANGE HOOD <br />DOM EXHST FANS & DRYER VENTS <br />MECHANICAL BASE FEE <br />FLEET ,,SURCHARGE -ZONE 3 <br />MECHANICAl_ STATE SURCHARGE <br /> <br />PAYEE: TOM [}ORAN <br />RECEIVED BY: ¢1 <br /> <br />THIS IS NOT A PERMIT+ <br /> <br />9015798 <br /> <br />0UANTITY ¢~,MOUNT <br />1 $4-50 <br />3 $9.00 <br /> <br /> $3.84 <br /> $1,18 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$28.52 <br /> $0.00 <br />$25.37 <br /> <br />BALANCE DUE $3 ,, 15 <br /> <br />INVOICE NO: 16789 <br />TYPE: IN CHECK ~: O <br /> <br />THIS :APPLICATION MUST, 60 THROU~4 A REVIEI~ PR~X~E~?~..~ I~IERE 'fI-IE <br /> <br />FOLLONING ~J$T SE COMPLETED. IT IS THE R~PONSTBTL~ITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECE~:~ARY INFO~IATION HA~ BEEN PROVIDED. <br /> <br />PLAN REVIEW+, BY .......... DATE <br /> <br />REMARKS: 1 UTILITY FAN, BATHROOM, DRYER <br /> <br />CITY JURISDICTIONs BY .......... DATE ......... <br /> <br />FONMdMOI55~ ee¥ I1~ OFF,CE COPY <br /> <br /> <br />