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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG NO,, 225 <br />220 HIGH S-TREET 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 ',~ork on a property I own or occupy <br /> <br />of ~ registered builder <br /> <br />I have read and agree to the terms stated or~ the reverse side of <br /> <br />SIGNATUB6 OF APPLICANT <br /> DATE <br /> <br />OATE: 11/2'//90 ]'.[ME; 1'tt33:05 <br /> <br /> f',1AR r l N, BE~OE <br /> <br />TAX LOT CATEGORY <br />CONSTRUCTION TYPE OCCUPANC~ <br /> <br /> 9218 Sf'AY'f(2N RCA0 <br />AUMGVi LLE OR 97325 <br /> <br /> CONTRACT CiTY LJGB OCCUPANT LOAD <br /> <br />MARION COUN fy NO <br /> NO OF BEOROOM5 <br /> <br />MAILING ADDRESB SUI~DIVlSION <br /> <br /> PHONE: f69-5385 <br /> <br />LOT BLOCK SECTION TOWNSHIP <br /> <br /> 1.5 <br /> <br /> ~I l'E NUIV~R: 11725 <br /> VALUAIION: <br /> RANGE ZONE <br /> <br />9S lW EPU <br />AC NO NO <br /> <br />MAP <br /> <br /> 59 <br /> <br />[YPE: PLurvlE11NG <br /> <br />CON IRA, OTOR, NO. <br />~IARf IN, bCE550E <br /> <br />PER~II OR APPLiCAIiON NO= <br /> <br />287?3 <br /> <br />PHONE: 769-b385 <br /> <br /> iTEM <br />~AfbR L.[NES, 1ur 100 ?EEF <br />~LAIER LINES, EA_ A~I)L.. 100 F~bI <br />~OBiLE HOM~ 5~W~R AND WAI~R CC~NECFION <br />FLEE[ SURCHARGE -ZONE 3 <br />PLUmiNG 5fAIE <br /> <br />'IOTAL A~C,SE,~SED FEE5 <br />PREWIOU~ RECEIPIS <br />1HIS RECE.[Pl <br /> <br />BALANCE DUE. <br /> <br />QUANfiYY <br /> 1 <br /> 1 <br /> <br />$20.00 <br />~15.00 <br />25.00 <br /> $3.84 <br /> Ss.u0 <br /> <br /> $o.0o <br /> <br /> PAYEE: RECEIPT NO: <br /> N~.CEiVEO ~Y; CL rYPE: CHECK ~: 0 <br /> <br />· fIHi5 IS A VALID RER~iT * THIS PERMIT EXPIRES 180 DAYS FROf4 iTS i~E DATE. IF <br />OON~II~CT.[ON CF_A~ES ~OR A P[R~OD OF 180 ~, OR tP ~f~Of~ FA~L~ TO MEET ALL <br />R~UtR~T~ OF STATE ~ ~O ~R~ ~NTY BU[LO[N~ ~O Z~ZN~ ORDZN~C~, rH~ PB~tT <br />~ALL BEdE NULL ~O ~O. <br /> <br />REM4RK.,5: WL/CONN R~622 <br /> <br />OON,~L0 E. ~OODLEY, MARION COUNIY BUiLDiNG OFFICIAL. / BY <br /> <br />FORM # MC 15,56 REV 4/90 OFFICE~COPY - <br /> <br /> <br />