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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 9"7301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />l am a registered builder OR ( ) the authorized representative <br />Other_ <br /> <br /> ~ have read and agree to the terms stated On the reverse side of <br /> this document, <br /> <br /> DA'rE: 04/'23/91 'riME= 8z 59.* 47 <br /> OWNER: <br /> PARKER, NAOmi L. <br />~ SITUS ADDRESS; <br /> <br /> 10868 ~ZN s'r <br />DONALD <br /> <br />OR <br /> <br />SIGNATURE OF APPLICANT: <br /> <br /> ' TAX LOT: j CATEGORY; <br /> r 40?64-000 RESf DEN 1' I~L <br /> ! OCcuPancY; <br /> <br /> NE i"~o~+~¢ CitY: U~B: i 0CCUPANT LOAD; <br />97020 ; <br /> <br /> NO 0F 6EDR00~S: <br /> <br />P.O. BOX 451 <br />DONALO, OR 97020 <br />PHONE: 6?8-5948 <br /> <br /> LOT: BLOCK: SECTION: <br /> <br /> 17 <br />'WIDTH: DEPTII: AREA: <br /> 11 O. 85 9350 <br /> <br /> SiTE NUI~ER: 12747 <br /> VALUAT ION: <br />l ToWN~NiPi , RANGE: ZGt~E: :MAP: <br /> <br /> SF NO] NO <br /> <br />TYPE: PLUFE~iNG <br /> <br />PER~IT OR APPLiCATiON NO: <br /> <br />CONTRACTOR, NO. <br />PARKER, NAOmi E. <br />P.O. BOX 451 <br />CONALD, OR 97028 <br />PHONE: 6?8-5948 <br /> <br /> iTEM <br />HATER LINES, 15'f 100 FEE'r <br />IN~TER LINES. EA+ ADDL+ 100 FEE1 <br />SEiNER L~NE.,,%~ 1s'r 100 FEE'f <br />~F.~ER LINES, rEA. AOOL. 100 EEE'f <br />rfl0~ILE HONE ~EWER ~O WATER ~NECTI~ <br />PLUmiNG STATE ~A~E <br /> <br />31623 <br /> <br />fO'rAL '~ED FEE~ <br />'PREVIOU~ RECEIPTS <br /> THiS RECEIPT <br /> <br />QUANTITY /~NI' <br />1 $20.00 <br />3 $45+00 <br />1 $30.00 <br /> $45.00 <br />1 $25.00 <br /> $e.25 <br /> <br />¢173.25 <br />147.00 <br /> $26.25 <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE: iaVOICE NO: 33488 <br />RECEIVED BY; CL. . .................................................. ]'YPE:~;~] OH__ . ECK.,L ...... 0 <br /> <br />FORM # MC 15-56 REV. 4/90 <br /> <br />RETflARK~: 400 Fl' WATER & ~EHER LINES MH PIBG CON <br /> <br />DONALD E. W~OODLE¥, ~4kRioN COUNTYBUILDiNG OFFICIAL / BY <br /> <br /> OFFICE COPY <br /> <br /> <br />