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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-?'904 // ']~-"'--- --' <br /> <br /> amaregisteredbullderOR( )the authorlzedrep,esentat,ve SIGN~TURE OF App~~¢~ ~>~~ <br />of a registered builder. ~ ~ ' <br />fho work will be performed by a registered builder <br />OtheL <br />have read a~d agree to the terms stated on the reverse side of DATE <br /> <br />ow[~L~TE: 12/17/90 TIME; <br /> PERES, GARRE'I 1' <br /> <br />TAX LOT CATbGOHt <br />CONSTRUCTION TYPE OCCUPANCY <br /> <br />RE'SI OEN <br /> <br /> 7919 MILL CRt:EK ROAD <br /> AUM~VILLE OR <br /> <br />USE OF BUILDING <br /> <br /> ~ CONTRACT CITY UGB <br />97325 <br /> MARION Ot.~N T Y NO <br /> <br />$10NE FIELD GLEN <br /> <br />740 B~Y~NP.~ ROAD 5E <br />,~LEM 9?306 <br />PHONE: 3'10-7556 SI1E NU~ER~ 11950 <br /> VALUA f ~ ~ ~ <br /> <br />WIDTH <br /> <br />1 26 83 2W AR 51 <br /> DEPTif AREA UNITS IRREG LOT CORNER <br /> <br /> 5. AC NO NO <br /> <br />tYPE: PLUMBING <br /> <br />CON IR/~IOR, NO. <br />PE'rE~, GARREIT <br />740 BO(.~ES ROA£) SE <br />SALF=Tfl 97906 <br />~E: 370-7556 <br /> <br />PERMiI' OR APPLiCAtION NOt 9029356 <br /> <br /> ITE~I <br />NA[ER LINES, 1s'r 100 rEEF <br />~C~ILE HO~E SEWER AND ~'&ATER CONNECrlON <br />PLUIVlSlNG BASE FEE <br />FLEET ..~URCHARGE -ZONE 9 <br />PLU~[NG 8TALE SURCHAROE <br /> <br />TOTAL A,S~8,E~ED FEES <br />PREVIOUS RECEiPfS <br />THIS RECEIPT <br /> <br />C~UAN r I 1Y A~N t <br /> <br /> 1 <br /> $20.00 <br /> ~3.84 <br /> 3.25 <br /> <br />$72.09 <br />$0.00 <br /> <br /> ~BALANCE !.AJE $0.00 <br /> PAYEE: PEIER~ON, GARRE"rT I ~1 RECEIPT NO- 310Pn <br /> <br />* THIS IS NOT~P£Rt~iIT, TM-~APCN_iC~TION~T (~C) THROUGH A RE~/IE(N P~--'[NHERE THE <br />POLLOHiN® MUBT BE CO~IPLETED. IT 15 THE RESPONSIBILITY Off THE APPLICANT TO ASF:~RE THAT <br />ALL NEC~RY INFORMATION HAS S£E~I PROVIDED. <br /> <br />PLAN REVIEW: BY <br /> <br />REMARKS: ~A]ER LiNE/CONN <br /> <br />DA'rE <br /> <br /> R~477~ <br /> <br />CITY JURISDICTION: 8Y DAtE <br /> <br /> OFFICE COPY <br />FORM # MC 15-58 REV 4/90 <br /> <br /> <br />