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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM~ OREGON 97;301 <br /> <br /> PHONE: 588-5147 8;00 - 4;30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />Other <br /> <br />SIGNATURE OF APPLICANT: <br /> DATE; <br /> <br />OWNER; <br /> OA'¥'E: 05/2~'/90 'FIIVlE~. 12:36:5~ <br />S~TU$ ADC~ES~U].].ER' RALPH <br /> <br />855 CLEVELAND <br /> <br />97325 <br /> <br /> TAX LOT: <br /> CONSTRDOTION TYPEI 90012-011 <br /> CONTRACT CITY; UGB: <br /> <br />AU~,SV 1 LLg NO <br /> <br />CATE(~ORY; <br /> <br />OCCUPANCY: RESi DEN 'l I AL <br /> <br />FO BOX 12533 <br />SALEM OR 97309 <br /> <br />WIDTH: DE~TH. AR~A: U~; <br /> 2 1 25 85 <br /> <br />AUt'~,~V i L LE ME]A~ <br /> <br />: ~E NUMBER: ZONE: 10231 MAP: <br /> '""%TALUAT ~ON: <br /> <br /> 2W <br /> <br /> NO NO <br /> <br />,. 'fYPE: PLUM81NG PERMIT OR APPLiCATiON NO: 9024243 <br /> <br />Cr,~N'I'RAC'I'OR, NO. 16078 <br /> <br />t615 PiNE S'I' NE <br />SILVER'FON, OREGON 97381 <br />PHONE: <br /> <br /> iTEM <br />RgSIDEN'riAL FIXTURE, NEW CONS'r_ <br />P~UMSiNG BA,SE FEE <br />FLEET ~URC~ARGE -ZONE 3 <br />P~UIV~ING STATE SURCHARGE <br /> <br />TO'rAL ASSF_.S~ED PEES <br />PRS¥ J, OUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANI'iI'Y ~N'¥' <br /> 6 $5a_00 <br /> $~0.oo <br /> $3+84 <br /> $3.70 <br /> <br />$8t.54 <br /> $o,oo <br />$81.54 <br /> <br />PAYEE: RALPH ~iiLJfTER ' <br />RgCEiVEO BY: PB <br /> <br />~ALANCE DUE $0_00 <br /> <br />INVO[C6 NO: 25689 <br />TYPE= IN CHECK ~= O <br /> <br />* THIS 15 NOT A PER,.IT. THIS: APpL.[CATION ll[IST GO THR~.II~-I A REVIE~ PROCE~F:~ ~-IERE THE <br />~=OLLE~ING MU,ST BE COf4PLE~IED~: IT I-~ THE R,E~P(TNS[IBILJ. TY OF THE APPLICANT TO ~RE THAT <br />ALL NEC~PC5GARY INFOR~IATION H~S 8E~ PROVIDED. <br /> <br />PLAN REVIEW: BY .................................. DATE ....................................... CITY JURiSDICTiON: 8Y .............................. DATE ........................... <br />RERt~RKS: 6 FiX <br /> <br /> OFFICE COPY <br />FORM # MC 15-56 REV. 4/90 <br /> <br /> <br />