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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 />SIONATURE OF APPLICANT <br /> DATE <br /> <br />OWNER <br /> <br /> L~A r b: 1 o/1 '~'/9o <br />SITUS ADDRE <br /> <br />TIME: 8:18:24 <br /> <br /> ?45 MIOHAEL WAY <br />us~ OR 97325 <br /> <br />TAX LOT CATEGORY <br />CONSTRUCTION TYPE 57816-909 OCCUPANCY R~.~,i DEN { IAL <br /> <br />CONTRACT CITY UGB OCCUPANT LOAD <br /> <br />AUMSVILLE NO <br /> <br /> P.O. BOX 290 <br /> AJJPff:~IVILLE, OR <br />LoCPHONE: <br /> <br />97325 <br /> <br />ASEA UNITS <br /> 25 <br /> <br /> ~ NUfclf~ER: ZOnE 11453 <br /> VALUA1 iON: <br /> <br /> IRREG LOT CORNER <br />8S 2~ RS <br /> <br />MAP <br /> <br />lO0 3{5 0. <br /> <br />SF Y~ NO <br /> <br />PLUMBING <br /> <br />PERMi1 OR APPLiCAFiON NO: <br /> <br />OJNFRACTOR, NO. 28638 <br />I'.6.NICHOL FLUffING, JNC <br />P.O.8OX 186 <br />AUIv~ViLLE, OR 97325 <br />PHONE: 749-2071 <br /> <br /> iIE,{V] <br />R~iOP-..~TIAL FiXFURE, NE~ <br />~AI'ER LiNE~, 1SI 100 FEEl <br />5EWER LIN~. 18r 100 FEEF <br />PLUMBING BA,~E FEE <br />FLEEr LSUF~CHARGE ~ZONE 3 <br />PLUMBING STATE SURChArgE <br /> <br />PAYEg: {.G.NiCHOL PLUr4BiNG, INC <br /> <br />90280?9 <br /> <br />TOTAL ~ED FEEL5 <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />T~)U~III'Y ~NI <br /> 16 $144.00 <br /> <br /> $20:00 <br /> $s.84 <br /> $ lO. ?o <br /> <br />$228.54 <br /> $o.oo <br />$228.54 <br /> <br />BALANCE DUE $0.0o <br /> <br />INVOICE NO: 29871 <br /> <br /> RECEIVED BY: PR TYPE: iN C~ECK ~: 0 <br />· THIS IS NOT A PEI~41T+ THiS APPLICATION MUST 60 THROU(.-~t A REVIE~ PROCE8~ WHERE THE <br />POLLONING MUST ~E COMPLETED. IT 1~ THE RE~SPONSIBILITY OF THE APPLICANt TO ~RE FHAT <br />ALL NEC~RY iNFORMATION HA~ ~EEN PROVIOEO+ <br /> <br />PLAN REVIEW: BY DATE <br /> <br />REMARKS: 16- FIX, N/S LiN~'~ <br /> <br />CiTY JURISDICIION: BY <br /> <br />OAT E <br /> <br /> OFFICE COPY <br />FORM # MC 1 ~,$6 REV 4/~0 <br /> <br /> <br />