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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 />SIGNATURE OF APPLICANT: <br /> 0ATE: <br /> <br />TAX LOT; <br /> <br />~ONS~RUCTION TYPE: <br /> <br />7757 SHERf4AN RD 8E CONTRACT CITY: : UG8: <br />AUMSVi LLE OR 9?325 <br />usc or ~U,L:~,NS: I~tARJ_ON O'f,A~N'rY NO <br /> <br />CATEGORY: <br /> <br />OCCURANCY: <br /> <br />RESJDEN']'iAL <br /> <br />510 SW ?'tH <br />~JBLIIVlI'I'Y OR 9'1385 <br />PHONE: '169-5969 <br /> <br />BLOCK: <br /> <br />CAMELLIA HEIGH'fS NO.3 <br /> <br /> SITE NUFSER: 10906 <br /> VALUA'[ I ON ~ <br />:s~d~ib~: TOWNSHIP: ' RANGE: ZONE: <br /> <br /> ; ~REA: 29 UNITS: 8~;~ IRREG LOTI lW CoRNERI AR <br /> <br />TYPE: MECHANICAL <br /> <br />MAP: <br /> <br />48 <br /> <br />CON I'RACTOR, NO. <br />ANOAL, D,F, & 8.J, <br />510 ~1 7 TH <br />.~¢JBL iM 1TY OR <br />PHONE: ?69-5959 <br /> <br />PER~II'I' OR APPLiCATiON NO: 26292 <br /> <br /> tTi~I <br />H F_..:A 'r PuMP <br />¢.x3~E~'i-ic RANGE HOOD <br />DOM ~ST F/U'4S & DRYER VENTS <br />I'flEONANiOAL BASE FEE <br />FLEET ,SURCHARGE -ZONE 3 <br />~4ECHAN[CAL STATE SURCHARGE <br /> <br />TOTAL AS,SEE~ED FEES <br />PREViOUf~ RECEIPTS <br />'rHZ8 RECEIPT <br /> <br />QUANTITY AI'4OUNT <br /> e.oo <br />1 $4.50 <br />~ $9~00 <br /> $~0.00 <br /> ~3.84 <br /> <br />$3~. 82 <br /> 34.82 <br /> $0.00 <br /> <br />BALANCE <br /> <br />PAYEE: RECEIPT NO: <br />RECEIVED BY: PFJ ......................................... ;.; .......................................... TYPE* CHECK ~: O <br /> <br />*THiS 18 A VALID PER,liT * YHI~PERhlIT EXPIRES 180 DAY~ FROM iTS iSSUE DATE. IF <br />CONSTRUCT/ON CEASES FOR APERIODOF'I:80 DAYS, ORiFCONSTRUCTION FAILS TO ~EET ALL <br />RE~IUIREBSENTS OF ~TATE LAW~ANDI~ARION C~UNTY BUILDING AND ZONING ORDINANCES, THIS PERMIT <br />E~HALL BECO~flE NULL AND VOID. <br /> <br />REI~ARKS: <br /> <br />OONALD E. W/OODLES, ~RiON COUNTY BUILDING OFFICIAL / BY <br /> <br /> OFFICE COPY <br /> <br /> <br />