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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG NO 225 <br />220 HIGH STREET RE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4.30 <br />24 HOUR CODE-A-PHONE:: 588-7904 <br /> <br />I ha~e read and agree to the terrns stated on the reverse side of <br /> <br />SIGNATURE OF APPLICANT <br /> DATE <br /> <br />OWN~fE: 10/02/9~ <br /> <br /> NOACK, MARK <br />SITUS ADDRESS <br /> <br />TAX LOT <br /> <br />CONSTRUCTION TYPE <br /> <br />CATEGOBY <br /> <br />OCCUPANCY <br /> <br /> 1~9 N 8TH BT <br />AU~SViLLE <br /> <br />rDR 9'/:~25 <br /> <br /> CONTRACT CiTY <br /> <br />AUt4~V [ LLE <br /> <br />UGB <br /> <br />NO¸ <br /> <br />OCCUPANT LOAD <br /> <br /> P.O. BOX <br /> PHONE: 749-4405 <br />LOT BLOCK SECTION TOWNSHIP <br /> 2,5 8~.~ <br /> ~0O 108 10800. SF <br /> <br />$iiE NUf~ER: 11487 <br />VALUA Ti ON; <br />mANGE i ZON~ <br /> <br />IR~E~ 'L(~T CORNER <br /> NO YES <br /> <br />NO OF BEDROOMS <br /> <br />MAR <br /> <br />MECHANICAL <br /> <br />CONfN~C[OR, NO- <br />NOACK, MARK <br />P-O. BOX <br /> <br />?49-4405 <br /> <br />P~F<~4iT OR APPLICAFION NO: <br /> <br />GAS CONNECTION <br />FLOOR FURNACE <br />GA5 WATER HEALER <br />MECHANICAL BASE PE~ <br />MECHANICAL 51AFE SURCHARG~ <br /> <br />PAYEE: NOA(;K, MARK <br /> <br />35'/40 <br /> <br />I"OTAL ~ESSEB FEES <br />fHiS RECglPl <br /> <br />AMOUNI <br /> <br /> $6.oo <br /> $?_50 <br /> $10,00 <br /> $~-28 <br /> <br />$28.78 <br /> $0_00 <br />$25, ?8 <br /> <br />BALANCE <br /> <br />iNVOiC~ NO: 3~565 <br /> <br /> RECEiVE[) BY: L~42 FYPE: iN CHECK ~: 0 <br />~ THIS IS A VALID PEI~IlT · THIS PEI~IlT EXPIRES 180 OAY~ ~ ITS IS,SUE BATE. <br />CONSTRUCTION CEASeS. FOR A PEI~IOD OF 180 BAYS, OR IF CONSTRUCTION FALLS TO ~EET ALL <br />REQUtREI~ENTS DF STATE ~ AND ~RION COUNTY BUILDING AND ZONING ORDINANCE.~, THIS PER~qlT <br />~ALL BECO61E NULL AND VOID. <br /> <br />REMARKS; GL./~-LOOR FURNACE/NB ~(~ 7 <br />OONALL) E. ~¢OOL)LEY, MAf'~ION COUNIY BUILDING OFhI(;IAL / BY .................. <br /> <br />FORM # MC 15-66 RE'V zl/90 OF FICE COPY <br /> <br /> <br />