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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG NO 225 <br />220 HiGH STREET NE <br /> SALEM, ~O~qEG®N 97301 <br /> <br /> PHONE: $88-5147 8'00 - 4::30 <br />24 HOUR CODE-A-PHONE:: 588-7904 <br /> <br />I ha~e read and agree to the terms stated on the reverse side of <br /> <br />SIGNA)URE OF APPLICANT <br /> DATE <br /> <br />ow~l~lE: 11/02/90 <br /> <br /> Wf=,LL~, DIANE <br />SITUS ADDRESS <br /> <br />7 iME.* 13 =52+. 0O <br /> (BLAINE} <br /> <br />TAX LOT <br /> <br />CONSTRUCTION TYPE <br /> <br /> 620 N I%~.PLE SI <br /> AU~Vi LLE <br />USE OF BUILO~NG <br /> <br />OR 9?325 <br /> <br /> CONTRACT CiTY <br /> <br />4/JM~ViLLE <br /> <br />UGB <br /> <br />CATEGORY <br /> <br /> RESIDENIiAL <br /> <br />OCCUPANT LOAD <br /> <br /> PRONg: 74.9-1428 <br />LOTSLOCK <br /> <br />WIDTH DEPTH <br /> <br />Si f'E NUNFBER: 11639 <br />VALJUA r iON: <br /> <br />IRREG LOT CORNER <br /> NO NO <br /> <br />TYPE: MECHANICAL PERMIT OR APPLJCA'FION NO: <br /> <br />28519 <br /> <br />CONIRACFOR, NO, <br />WELLS, DIANf= (BLAINK) <br /> <br />PHONE; '/49-!4.28 <br /> <br />~)ME~IIC W~>D STOVE <br />M~OHANiCAL BA~E FEE <br />FL~EF ~JRCHARGE -ZONE 3 <br />MECHANICAL SfAIE SU~;HA~E <br /> <br />(~LIANilTY AF'~)UNf <br /> 1 $?.5o <br /> $10,00 <br /> <br />TOFALASS~EO FEES <br />PREVIOUS RECEIPTS <br />THiS RECEiP'f <br /> <br />$22.22 <br /> $0.00 <br />$22.22 <br /> <br />BALANCE DUE $0.00 <br /> <br /> PAYEE: tNELLS, DIANE (BLAINE) INVOICE NO; 201,.43 <br /> RECEIVbD BY: DM2 tYPE: IN CHECK ~: <br /> <br />* THIS iS A VALID PE~IT ~ THiS PE~IT ~P1R~ 180 DA~ F~ Ir8 l~E DATE. iF <br />~sr~cli~ C~ FOR A PERIOD OF 180 DA~, OR iF ~S'F~CTI~ FAI~ TO NEE1 ALL <br />RE~IR~ENIS OF STATE ~ ~D ~RI~ ~N'FY BUILDiN6 ~O Z~iNG ORDiNANCe, THI~ PE~I1 <br />~ALL BE~ NULL ~0 <br /> <br />Rgt~ARK~: ~OOO S1OVE <br /> <br />tX)NALD ~. WOODLEY, MARION COUN'IY BUiLDiNG OFFICIAL / BY <br /> <br />OFF[CE COPY <br /> <br /> <br />