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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 perferm~ng work on a proporty I own o¢ occupy <br />lama registered builder OR i I the authorized representative <br />of a registered builder <br />The work will be performed by a registered builder <br />Other <br /> <br />SIGNATURE OF APPLICANT <br /> DATE <br /> <br /> D~I£: 11/17/90 'I~ME: 11:'~1:07 <br />SITUS ADDRESS <br /> R(.~ ER"I' GARF f ELD <br /> <br /> ~D~LEE OR 9 I325 <br /> <br />MAILING ADDRESS <br /> <br />LO~,~tONE: '14g--~6~: SECTION <br /> 11 <br /> <br />25 8S <br /> <br /> TAX LOT CATECORY <br /> <br /> CONSTRUCTION TYPE OCCUPANCY <br /> 57706/57 ? 07 RESI DEN r IAL <br /> <br /> CONTRACT CiTY UGS OCCUPANT LOAD <br /> <br />AUfv~VILLE NO <br />SUBDIVISION <br /> <br />EVERGREEN ES fAf ES <br /> <br />~1][ NUNBER: ZONE 11691 <br />VALUAT ],ON: <br /> <br />MAP <br /> <br />55 113 6215+ <br /> <br />SF NO NO <br /> <br />fYPE~ PLUNSING <br /> <br />ChONfRACfOR, NO. <br />ROBERT GARPiELD <br /> <br />PbRNIT OR APPLICATION NO: <br /> <br /> iTP,¢'4 <br />MOD],LE HO~E 5EWh,R AND WAFER CONNECf],ON <br />FLEET f::~URCHAR'GE -ZONE 3 <br />PLUIVtBiNG STARE SURCHARGE <br /> <br />0UAN f'.[ rY A~*f3JN r <br /> 1 $25.0O <br /> <br />TOTAL A.-~E~ED FEES <br />PREV],OUS R~E~PF$ <br />TH],$ RECEIPT <br /> <br />$30.09 <br /> $0.U0 <br /> <br />DUE $0.00 <br /> <br />PAYEE: iNVOiCE NO: 30405 <br /> <br />* THIS IS A VAL],D PERN[T * THiS PERI~I[T EXPIRES 180 DAY~ PROI~I ["rs [E,~!.JE DATE. <br />CONSTRUCT],ON CEA~E~ FOR A PER[OD OF 180 DAYS, OR ],F CON~TRLICT[ON FAILS TO ~EET ALL <br />REQU],REI~P.'N'I$ OF STATE ~ AND i~IAR[ON C~AJNTY BUILDING AND ZONING ORDINANCES, THiS PERMIT <br />311'-IALL BECOIVlE NULL AND VOID. <br /> <br />REt4ARK2,: ~ CON <br />L)(3~ALD E. WOOBLEY, IV~ARiON COUNfY BUiLDZNG OPF],C~AL / BY ..... ~ .......... <br /> <br />FORM # MC 15-56 R~¢ 4/90 OFFICE COPY <br /> <br /> <br />