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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 8:00 - 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 ~m a re(~istered builder OR the authorized representative <br /> of a registered builder, <br />The work will be performed by a registe(ed builder. <br />Other <br />I have read end agree to the torres stated on the reverse side of <br /> <br />SIGNATURE OF APPLICANT: <br /> DATE: <br /> <br />OWNER: <br /> OA'I'E: 06/'14/90 TIME: 14:41:43 <br />SITUS ADDRE~.~JUT'1.ER' RAL,OH <br /> <br /> 855 CLE~v'EL.~,NID ST <br />u s~aCJMS~C-~L~E <br /> <br />MAILING ADDRESS: <br /> <br />OR 97325 ..... <br /> <br /> TAX LOT: <br /> CONSTRUCTION TYPE; <br /> CONTRACT CITY: <br /> <br />AU~VILLE <br /> <br /> SUBDIVISION: <br /> <br />P.O+ 8OX 12533 <br />SALEM,OR 97309 <br /> <br />'10rJ <br /> <br />NO <br /> <br />CATEGORY. <br /> <br />OCCU~-NCY: RF-~I OENTIAL <br /> <br />OCCUPANT LOAO: <br /> <br />AUM:~VI LLE MEADO~ <br /> <br /> IRREG. LOT: CORNER: <br />8S 2H RS <br /> <br />~'F" NO NO <br /> <br />MAP: <br /> <br />TYPE: PLUMBING <br /> <br />CONTRACTOR, NO. <br />~;~tTTER, RALPH <br />P.O. BOX 12533 <br />.?¢.LFJ4,OR 9?309 <br />PHONE: 588-2373 <br /> <br /> ITE~ <br />HATER LINF~, 1ST 100 FEET <br />SEWER LINd, 1S'F 100 FEET <br />FLEET E~IRCHARGE -ZONE <br />PLUMBING STATE <br /> <br />PAYEE: <br /> <br />PE~IT OR APPLICATION NOs 24244 <br /> <br />'1 $20_00 <br />'1 $~0. O0 <br /> <br />TOTAL A,E~EO FEES <br />PREVIOUS RECEIPTS $56.34 <br />'THIS RECEIPT $0.00 <br /> <br />BALANCE BUE $0.00 <br /> <br />INVOICE NO: <br /> <br /> RECEIVED BY: F'B TYPE= CHECK ~: 0 <br />x~ THI~5 IS A VALID PERI,IT * THIS .e~[T I~XPII~ 180 OAY~ :PRO~ IT~ I~E ~TE. IF <br />~T~TI~ <br /> ~ ~TATE ~ ~ ~I~ ~ ~I~I~ ~ Z~I~ ORDIN~C~, ~I~ ~IT <br />~llm~ ~ ~ A P~:~ 180 ~, m IF~T~TIm FAI~ TO ~T ALL <br /> ~ ~O ~I0 <br /> <br />R~RKS: WL SL <br /> <br />DONALD E. <br /> <br />OFFICE COPY <br /> <br /> <br />