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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 /> DATE <br /> <br />OWN~TE: 83/28/9t riME~. <br /> <br />s~rus ADDRESCF.)O[,)~AI'~.), MICHAEL <br /> <br />1050 N- 4TH <br /> OR S732S <br /> <br />MAILING ADF~R6 SS <br /> <br /> CONSTRUCTION TYPE 578 ~ O~IDO0 <br /> <br />AMFIE, V 1 LLE NO <br /> <br />OCCUPANCY RESI DEN1/AL <br /> <br />P.O. BOX 287 <br />AUI~ViLLE <br />PHONE: 749-3~04 <br /> <br /> SiTE NUJN'IBER; 12551 <br />TOWNSHIP RAN~C~LUAT I ON: ZONE MAP <br /> <br />25 Ul~l'r S ~S I~RC-G LOT 2W GORHER R~ <br /> <br /> ..... SF YElL NO <br /> <br />fYPW: PLUt~,~ING <br /> <br />PERi, IT OR APPLICATION NO: 31187 <br /> <br />C(~tRIAC'fOR, NO. 28638 <br />T.G_NIC~OL PLUiVIBING, INS <br />P.O.80X 166 <br />AUIvI~ViLLE, OR 97325 <br /> 749-2071 <br /> <br /> iTEM <br />RE-LOCA'iED RBSIDENCE PIXrURE <br />PLUIV]F~iN~ BASE FEE <br />PLUFIBIN6 STATE E~JRCHARGE <br /> <br />TOTAL ASS. Ec.S~ED FEE8 <br />PREVIOUS RECEIPTS <br />THIS RECEZPI <br /> <br />QUA~IfiTY AI~Ni <br /> 5 $22.50 <br /> $20.08 <br /> <br />$44.63 <br /> $o.oo <br /> <br />BAL-~NCE DUE $0.00 <br /> <br /> PAYEE: i Nyr-.) ICE NO: 32938 <br /> RECEIVED BY: PR 'rYPE:"~C~ CHECK ~: o <br />:~ THIS IS A VALID PE.I~iT :~ THI~ ~IT ~PiR~ 180 ~ F~ ITS I~E ~TE. <br />~T~T[~ ~ ~ A P~[~ OF 18o ~. OR IF ~T~TI~ FAIG TO ~T ALL <br />~[R~ ~ STATE ~ ~D ~[~ ~ ~[LD[~ ~O Z~[~ ORD[N~C~, <br /> <br />RENARKS: 5~ RELOCATED FiX <br /> <br />DONALD E. ~ODLEY, ~4ARiON COUNfY BUILDING OFFiCiAL / BY <br /> <br />FORM # MC 15-56 REV 4/90 OF FICE COPY <br /> <br /> <br />