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MARION COUNTY BUILDING INSPECTION <br />SENATORBLDG NO 225 <br />220 HIGH STREET NE <br /> SALEM~ OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4'30 P..M - 800 AM <br /> <br />I am performing work on a ptoport~ I own or occupy <br />lama egseedbu der OR he authorized representative <br /> of a registered builder <br />lhe work will ge performed by ~ registered builder <br />Other <br />J have read and agree to the terms stated on the re~erae side of <br />this document <br /> <br />DATE <br /> <br />OWNER <br />DATE: 11/28/89 <br /> <br />SITUS ADD~, TOM <br /> <br />TIME: 10:30:01 <br /> <br />TAX LOT <br /> <br />CONSTRUCTION TV"~0040--080 <br /> <br />CATEGORY <br /> <br />OCCUPANCY RESIDENTIAL <br /> <br />865 9TH ST <br /> <br />MAILING ADDRESS <br /> <br /> CONTRACT CiTY UGB <br /> <br />AUMSVI LLE NO <br /> SUBDIVISION <br /> <br /> PO BOX 185 <br /> SUBLIMITY OR 97385 <br /> PHONE: 769-73~6~cK <br />LOT <br /> <br />SECTION TOWNSHIP <br /> <br /> DELMAR I I I <br /> <br />SITE NUNaER: <br /> P~[~JAT I ON: 'ZON~ <br /> <br />7377 <br /> <br /> AREA UNITS <br />WIDTH9 D~ PT~i 4 24 <br /> <br /> ?5 ..... 100 <br /> <br />8$ <br /> <br />IRREG LOT~w CORNER <br /> <br /> YES NO <br /> <br />51 <br /> <br />TYPE: MECHANICAL PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. 55493 <br />TOM BORAN <br />PO BOX 185 <br />SUBLIMITY 97385 <br />PHONE: 769-7364 <br /> <br /> ITEM <br />DOMESTIC R.aC4GE HOOD <br />DO~ EXHST FANS & DRYER VENTS <br />MECHANICAL SASE FEE <br />FLEET SURCHARGE -ZONE 3 <br />MECHANICAL STATE SURCHARGE <br /> <br />9020461 <br /> <br />~JANTITY <br /> 1 <br /> 3 <br /> <br />TOTAL,ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />BALANCE DOE <br /> <br />ANOUNT <br /> $4.50 <br /> $9.00 <br /> $1o.oo <br /> $3.84 <br /> $1.18 <br /> <br />$28.52 <br /> $0.00 <br />$28.52 <br /> <br />$0.00 <br /> <br />PAYEE: TOM DORAN ~'~ INVOICE NO: 21714 <br />RECEIVED BY: P8 - . ~.... TYPE: IN CHECK :~: 0 <br /> <br />~ ~IG IS NOT A P~IT. ~IS APPLI~TI~ ~ST $ ~ A ~I~ P~ ~ERE ~E <br /> <br />PI,.A~ REVIEW: BY .......... DATE <br />REMARKS: HD VT <br /> <br />CITY JURI%~ICTION= BY <br /> <br />DATE <br /> <br />OFFICE COPY <br /> <br /> <br />