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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4::30 pM - 800 A..M <br /> <br />I am performing work on a property I own or occupy <br />I am a reg stered builder OR I the aothorized representatiwe <br />of a registered builder, <br />The work will be pe ormed bya egis eredbui[dPr <br />Other <br /> <br />SiGNATUSE OF APPLICANT <br /> DATE <br /> <br />11/28/89 <br /> <br />TIME: 10:29t46 <br /> <br />TAX LOT <br /> <br />CONSTRUCTION <br /> <br />OCCUPANCY RESIDENTIAL <br /> <br />865 9TH ST <br /> <br />OR 9'732~ <br /> <br /> CONTRACT CITY UGS <br /> <br />N. JNSVILLE NO <br /> <br />OCCUPANT LOAD <br /> <br /> DELMAR III <br />PO BO× 185 <br />SUBLIMITY OR 97386 <br />PHONE: 769-7364 SITE NUMBERs <br />LOT BLOCK S~CTION TOWNSHIP ~A[~ATION: ZONE <br /> <br />7377 <br /> <br />MAP <br /> <br />WlDTH~ DEPTH 4 AREA 2~ UNITS 8S IRREO LOT2W CORNER <br /> 75 100 "SF ......, ,~o ,.,,., <br /> <br />61 <br /> <br />TYPE: PLUMBING <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. 44551 <br />BNAIN BETHEL & ,',SONS EXC <br />P.O. BOX 504 <br />TUFTER OR 97392 <br />PHONE: 743~2343 <br /> <br /> ITEM <br />MATER LINES, 1ST 100 FEET <br />SEWER LINES, 1ST 100 FEET <br />FLEET SURCHARGE -ZONE 3 <br />PLUMBING STATE SURCHARGE <br /> <br />PAYEE: TON DORAN <br />RECEIVED BY: PB <br /> <br />* THIS IS NOT A PE~IT. <br /> <br />9020460 <br /> <br />QUANTITY <br /> 1 <br /> 1 <br /> <br /> TOTAL ASSESSED FEES <br /> PREVIOUS RECEIPTS <br /> THIS RECEIPT <br /> <br /> BALANCE DUE <br />  INVOICE NO: <br />~'~: ::: :: -- TYPE: IN CHECK <br /> <br /> Af,'~UNT <br /> ¢20,o0 <br /> 30.00 <br /> $3-84 <br /> $2.50 <br /> <br /> $56.34 <br /> $0.oo <br /> $56.34 <br /> <br /> $o,oo <br /> <br />2171~ 0 <br /> <br />THiS APPLICATION ~T GO TH~ A REVII:~ Pi~:~ WHERE THE <br /> <br />FOLLONiNG I~UST BE COf4PLETED. IT IS THE RES~IBILITY OF THE APPLIC-~N~T TO A_%.,WJRE THAT <br />~LL NECESSA~ INFORIffATION HA~ SEEN PROVIDED. <br /> <br />PLAN REVI~: BY .......... DATE <br />RC/~4ARKS: WATER/SENER LINES <br /> <br />CITY JURISDICTION= BY ....... DATE ....... <br /> <br />OFFICE COPY <br /> <br /> <br />