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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 225 <br />220 HIGH STREET NE <br /> SALEM, (~REGON 97301 <br /> <br /> PHONE: 588-5147 8:0O - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> I am performing WOrk on a property I own or occupy. <br /> I 8m Et registered builder OR Ihs authorized repfesen Et Ive <br /> of a registered builder, <br /> The work will be performed by a registered builder. <br /> Other <br /> I have reed and apres o he e ms s a ed on the everse side of <br /> this document. <br /> <br /> DA'f'£: 07/10/90 TIME-+ 11:41:14 <br /> 6ROF'I', VERN <br />SITUS ADDRESS: : O0N~RLICTION TYPE; <br /> <br /> 11'123 NAR~3LER LANE NE '7 i <br /> AURORA OR 9'F002 : CONTRACT CITY: ' U~S: <br /> ClARiON COUNTY , <br /> <br />DATE; <br /> <br />TAX LOT: CATEGORY: <br /> RESI DENT IAL <br /> <br />NO <br /> <br />OCCUPANCY: <br /> <br />OCCUPANT LOAD: <br /> <br /> PREI~TiGE I~ 8F"'RVICE 97062 <br /> 8660 ~ G~E~KEE ST TUA~TIN,OR <br /> PH~E: 692-4256 SITE NU~ER: 1035~ <br /> VALUAT <br /> <br /> 7 33 : 3S <br />'WIOTH: DEPTH; A~EA: ~ dNITS: SF IRREG. LOT: NO <br /> <br />CF_.N TU R~ MEA~ <br /> <br />MAP: <br /> 1 <br /> <br />TYPE: PLUIt~ iNG <br /> <br />PERMIT OR APPLIOATiON NO: 24600 <br /> <br />~I'~TOR, NO. 64981 <br />PRESTIGE M08iLE HOC4E SERVICE <br />8660 SN CHEROKEE ST <br />TUALATIN, ORE~ 97052 <br />PHONE: 692-4255 <br /> <br />HATER LINE'S, 1ST 10O FEET <br />SEHER LINES, 1ST 100 FEET <br />I~[LE HOC4E SEWER .~ID WATER CONNECTION <br />FLEET .SURC4HARGE ~ZONE 8 <br />PLUMBING STATE ~URCHARGE <br /> <br />PAYEE: <br /> <br />QUANTITY AtvtC~JNT <br />1 $20.00 <br />1 $30.00 <br />1 $25.00 <br /> $'7.~8 <br /> <br />TOTAL~A,~SE88EDFEES $86.43 <br />:pREVIO.~RECEtPTS $88.~3 <br />:THIS RECEIPT $0.00 <br /> BALANCE CUE $0.00 <br /> <br />RECEIPT NO: <br /> <br /> RECEIVED BY: pp2 TYPE; CHECK ~: 0 <br /> ~ THIS IS A VALID PER~[T:~,THI~ PF_.~IT E[XPIRE~ 180[)AY~FRO~ ITS [~E ~TE. <br />~ST~TI~ ~ ~A..~I~:~ 180 ~, OR IF ~T~TI~ FAi~ TOE ALL <br />~~ OF STATE ~O'~l~ ~NTYBUILDiN6 ~O ~l~ O~IN~C~, THiS <br /> ~D~Io- <br /> <br /> ~ALD E. ~DLEY, ~R[~ ~NTY ~U[ED[NG OFF[C[AL/ BY ~ ......................................... <br /> <br /> OFFICE COPY <br />FORM ~ MC 15-58 REV. 4/90 <br /> <br /> <br />