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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; ~88-7904 <br /> <br />i am performing work on a property i own or occupy. <br />lam a registered builder OR( )theauthori~edrepfesentative <br />of a registered builder, <br />The work will be performed by a registered builder. <br />Other <br />I have read and agree to the terms s~ated on the reverse side of <br />this document. <br /> <br />OWNER: <br /> <br /> DATE: 09/18/90 <br />SITUS ADDRESS; <br /> REA CON.ST <br /> <br />USE oF ~ulL'b'~: 4'f'H- s'r <br /> AU~Vi LLE <br /> <br />OR 97383 <br /> <br />TAX LOT <br /> <br />CONSTRUCTION TYPE <br /> <br />AUt,tSV I LLE <br /> <br />NO <br /> <br />CA'fEGORY: <br /> <br />OCCUPANCY: <br /> RE~l DENT i AL <br />OCCUPANT LOAD: <br /> <br /> NO OF BFBR00M$ <br /> <br /> BOX 817 <br /> STAY'tON OR 97383 <br />LOT:~H~E: 749,-J~ <br /> <br />SECTION: TOWNSHIF <br />AREA UNITS <br /> <br />~C=E NU~ER~ ZONE <br /> VALUATION: <br /> RREG. LOT' CORNER <br /> <br />10971 <br /> <br />MAP: <br /> <br />NO NO <br /> <br />TYPE: PLUf~31NG <br /> <br />PERMIT OR APPLICATION NO: 26999 <br /> <br />CC,~TRACI'OR, NO. 51352 <br />REA CONS'F. INC. <br />P.O. BOX 617 <br />S'rAY'roN, OR 97383 <br />PHONE~ 789~6566 <br /> <br />R~IDEN'f'IAL FIXTURE, AL'FERATioN$ <br />PLUM~ING BA.~E FEE <br />FLEET ~I-IRCHARGE -ZONE <br />PLUMBING ~]'A'fE .SURE,~AR6E <br /> <br />PAYEE: <br />RECEIVED BY: PR <br /> <br />TOTAL AS~ED~ FEF_~S <br />PREVIOU~ RECEIPTS <br />'f'H l'q RECEIPT ~ <br /> <br />BALANCE DUE <br /> <br />QUANTITY .AIW. DUN'f' <br /> 5 $45_00 <br /> $20.00 <br /> 2.84 <br /> 2.25 <br /> <br />$72.09 <br /> <br /> $0.00 <br /> <br />$O.0O <br /> <br />INVOICE NO: <br />CHECK ~: 0 <br /> <br /> THIS 15 A VALID PERMIT · THIS PE~IT EXPiRES.~tSO DAY~ FROM ITS I,~SUE DATE. <br />~T~Ti~ ~ ~R A ~l~ OF 180 B~, OR:IF ~TBC~I~ FAIG TO ~f ALL <br />~I~T8 OF STATE ~ ~O ~I~ ~NTY ~l~l~ ~B Z~IN6 ~IN~C~, THI~ <br />~LL B~E NULL ~D <br /> <br />REMARKS: 5-FIX <br /> <br />DONALD E. VC,,X3DLEY, MARION COUNTY BUILDING OFFiCiAL / BY <br /> <br />OFFICE COPY <br /> <br /> <br />