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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 P,M - 8 00 A M, <br /> <br />I am performing work on a property I own or occupy <br /> <br />OWNBC~TE: 05/04/89 TIME: <br /> <br /> BERNING, BRETT <br />SITUS ADDRESS <br /> <br />12:16:48p <br /> <br />RESI DENT IAL <br /> <br /> ?20 MICHAEL NAY <br /> AUiVLSVILLE <br />USE OF BUILDING <br /> <br />OR 9?325 <br /> <br />CONTRACT CITY UGB OCCUPANT LOAD <br />AUIvlSV I LLE NO NO aP <br /> <br />SUBDIVISION <br /> <br />PO BOX 290 <br />AUMSVILLE OR 97325 <br />PHONE: '749-9576 <br /> <br /> PARCEL ~1 <br /> <br /> SITE NUMBER: 8004 <br />SECTION TOWNSHIP R~NG~ALUATION;zoNE <br /> <br />WIDTH DEPTH AREA <br /> 167 220 <br /> <br />25 UNITS 8S I~F~EG LOT 2W CORNEH RS 5! <br /> SF YES NO <br /> <br />TYPE: PLUMBING <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. 312 <br />EMERY & SONS CONST. <br />PO 8OX 398 <br />STAYTON, ORE 97383 <br />PHONE: 769--7751 <br /> <br /> ITEM <br />WATER LINES, 1ST 100 FEET <br />SEWER LINES, 1ST 100 FEET <br />FLEET SURCHARGE -ZONE 3 <br />PLUMBING STATE SURCHARGE <br /> <br />PAYEE: 8ERNING, 8RETT <br />RECEIVED BY: xxx <br /> <br />9017911 <br /> <br />QUANTITY AIvE)UNT <br />1 $20.00 <br />I $30.00 <br /> ~3,,54 <br /> 2.50 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$56.34 <br /> $0.00 <br />$56.34 <br /> <br />BALANCE DUE $0.00 <br /> <br />INVOICE NO: 19018 <br />TYPE= IN CHECK ~: 0 <br /> <br />* THIS IS NOT A PERf4IT. THiS ,APPLICATION IvIJSTGO THROUGH A RB/IB4 PROCESS I~..iERE THE <br />FOLLOWING IWJST 8E COMPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFORi~IATION HA~ BEEN PROVIDED. <br /> <br />PLAN REVIEW: BY .......... DATE CITY JURISDICTION: BY ........ DATE ......... <br />REMARKS: WATER SEWER LINE,S ~ <br /> <br />m~M · Mc ~-~6 ~ ,,,.. OFFICE COPY <br /> <br /> <br />