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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 /> am performing work on a property ) own or occupy. <br /> <br />of a registered builder, <br /> <br />Other, <br /> <br />this document <br /> <br />09/14/90 ~[ME: 12:55:15 <br /> <br />m[L~ER, JERRY - RPJ~TAL HOU~E~ <br /> <br />i~0NSTR~C~ION TYPE: OCCUPANCY: <br /> <br />RE,SI DF3'~ T i AL <br /> <br />~ 5555 HOi~ELL PRAIRIE RD :SE d0N~RACTCITY'. 'UGS: <br />,~ AUI~SV I LLE OR 97325 <br />:OSE OF BUtLDING~ ~RI~ NO <br /> <br />OCCUPANT LOAD; <br /> <br /> NO OF BEDROOM~ <br /> <br />MAILIN,G ADDRESS: <br /> <br />435 ,,N MACY ST <br />MCNiNNVtLLE, OR 97128 <br />PHONE: 472-7818 ~ SiTE NU~ER: 11092 <br /> VA~A~I~: <br /> <br /> 78 112.j 8738. ~ ~E NO <br /> <br /> TYPE: PLUFE~ING PEFi~111' OR APPLiCATiON NO.· 26903 <br /> <br /> O'ONTRAC'rOR, NO. 54802 <br /> JERRY MILLER <br /> % 435 N NAC~ s'r <br /> ', MCDIlNNVILLE, OR 97128 <br /> \ PHONE: <br /> <br /> ~, ITEM (~iJANT I TY AMOUNT <br /> ~DENTiAL FIXTURE, NBN CON:ST+ 6 ~54.00 <br /> P~JJMSiNG BASE FEE $20.00 <br /> FL~'IET SURCHARGE -Z~E 3 $3.84 <br /> PLUmiNG ~TATE ~A~E $3. <br /> <br /> ::..~O[AL ~E~ FE~ $81.54 <br /> ~R~[~ RECEIPT8 $81.54 <br /> : THiS R~EiPT $0.00 <br /> <br /> · : CE ~E <br /> <br /> PAYEE: ~: RECEIPT NO: <br /> RECEIVEB BY: ~ TYPE: ~ECK ~= <br /> .,, - .......... --..-- -, ,- ..,,,,~~: =~ '.~ ~;~ ~ ..... ;;:,,~..,=~:==~ ........ 0 <br />~ * ~1~ IS A V~ID P~IT:~ THI~ ~T ~I~ 180 ~ ~ I~ I~E ~TE. <br /> ~I~ OF ~TAT~ ~ ~O:~I~ ~ ~i~l~ ~O Z~I~ OROi~, THIS <br /> % ~ALL B~ NULL ~ <br /> <br />REMARKS.* 6 FIX R~4009 <br /> <br />gK2NALD E. [~OODLEY, MARION COUNTY BUILDING OFFiCiAL / BY <br /> <br /> OFFICE COPY <br />FORM # l~C 1 ~-56 REV, 4/90 <br /> <br /> <br />