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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 or~ a property I own or occupy. <br />I am a registered builder OR the authorized representative SIGNATURE OF APPLICANT: <br />Of 8 registered builder, <br />The work will be performed by a registered builder. <br />Other.__ <br /> <br />OWNER: <br />DAf'E: 05/22/90 TIME: q2:37:13 <br />S!TUS ^DOnESS~U.f..fER, f~.LPH <br /> <br /> 855 CLEVELAND ST <br />USE ¢.~JI~I~E OR 97~25 <br /> <br /> TAX LOT: CA f'EGORY; <br /> CONSTRUCTION TYPE: 900'12--011 OCCUPANCY: RESiOENI'IAL <br /> CONTRACT CITY: UGB: OCCUPAN1 LOAD: <br /> <br />AU~V! LLE NO <br /> <br /> PO BOX 12533 <br /> SALEM OR 9?309 <br />'LOll PHONE: 588~ <br /> <br />: SECTION: <br /> <br />75 <br /> <br />AUMSVJLLE MEA~ <br /> <br /> TOwN~H,¢ NUIViBER: ZONE: 10231 <br /> : '--¥ALUA r ION: <br /> <br /> UNITS: IRREG LOT~ CORNER: <br />25 8S 2~ RS <br /> <br />TYPE: PLUMBING <br /> <br />PERMIT OR APPLICATION NO: 9024244 <br /> <br />CONTRACTOR, NO. 34473 <br />HENRY ALLUiS EXCV. <br />43?6 FOREST RI E,~E RD NE <br />SiLVERTON, OREGC~ 97381 <br />PHONE: 873-4347 <br /> <br /> ITEM <br />~AI'ER LINES, 1S'¥ 100 FEET <br />~EWER LINES, 1S'f 100 FEET <br />FLEET SURCHARGE -ZONE 3 <br />PLUMBING STATE ~RCHARGE <br /> <br />PAYEE: RALPH SU'ff'ER <br /> <br />QUANf[TY AMOUNf <br />1 0.oo <br />I $30.00 <br /> ~3.84 <br /> 2.50 <br /> <br />TOTAL ASS~ED FEES <br />PRE¥[OU5 RECEIPTS <br />THiS RECEIPT <br /> <br />$5~.~4 <br /> <br />$56.34 <br /> <br />BALANCE DUE <br /> <br />RECEIVED <br /> <br />iNVOICE NO: 25690 <br />TYPE: iN CHECK ~: 0 <br /> <br />* TH15 iS NOT A PERI~IT. mISAPPUCATiONML~(~O mROU61-1A REVllBal PROCEr~S~I-I~-~ .... <br />~IN6 ~ST BE ~B$ : IT IS ~E ~ISILi~ E THE APPLI~T TO ~ THA~ <br /> <br />PLAN REVIEW: BY DATE <br />RbJVtARKS: NA'f'ER/SEWER L[N~ <br /> <br />CiTY JURiSDICTiON: BY DAlE <br /> <br />OFFICE COPY <br /> <br /> <br />