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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 /> DA'IE: O1/08/gl TIME: 15:49:01 <br />SITSS ADDRESS <br /> <br />SIGNATUHE i~ <br /> OF APPLICANT <br /> <br /> D <br /> <br /> TAX LOT CATEGORY <br /> 67644--014 RE51 DEN r i AL <br /> <br /> CONSTRUCTION TYPE OCCUPANCY <br /> <br /> 9292 SMITH RD SE <br />AUIv~V! LLE OR 9?325 <br /> <br />U5E OF BUILDING <br /> <br />CONTRACT CITY UGS OCCUPAN~ LOAD <br />M~RiON O¢,.~N T Y NO <br /> NO OF 8EDR00MS <br /> <br />MAILING AODRESS <br /> <br />SUSDIVISION <br /> <br />P.O. 983 <br />AUMS¥1LLE, OR <br />PHONE: 370-4569 <br /> <br />AC <br /> <br />~ITe NU~J~ER: 12059 <br />VALUA r ION: <br />RANGE ZONE <br /> 2W SA <br /> NO NO <br /> <br />]YPE; PLUM~ING <br /> <br />PERI'Ii OR APPLiCAIlON NO: <br /> <br />CvONfRACrOR, NO. <br />WILSON, mELVIN <br />P.O. 983 <br />AU~¢SVILLE, OR <br />PHONE: 370-4559 <br /> <br />WAIER LiN~, 1SI 100 PEEr <br />NAleR LINES, EA. ADDL. 100 FEET <br /> <br />I~L~iLE HC~E $ENBR AND NAT£R CONNECTION <br />PLUmiNG ~rArE ~A~ <br /> <br />PAYEE: WlL,~ON, JOHN <br /> <br />g029691 <br /> <br />IO1AL ASS~ED FEES <br />PREWIOU~ RECEiPtS <br />THiS RECEIPT <br /> <br />QUANIlIY AIv!OUNI <br /> <br /> $30]00 <br /> 1 $25.00 <br /> $4.50 <br /> <br />$94.50 <br /> $o.oo <br />$94.50 <br /> <br />BALANCE DUE $0.00 <br /> <br />RECEIP'I NO: 21268 <br /> <br /> RECEIVED ST: OL TYPE; OK CHECK ~: 306 <br />~ THI~ iS NOT A PE~ilT. THI~ APPLICATION r4UST GO THROU6H A REVII~ PROCEE~ 1~,4ERE THE <br />FOL[,.O~IN~ ~IJST BE COI~PLETED. IT IS THE RF~-poNSIBILITY OF THE APPLICANT TO ~RE THAT <br />ALL NECE~S~,ARY INPOI;~,IATION HAS BEEN PROVIDED. <br /> <br />PLAN R~VleW: BY ................... DATE <br /> <br />RE~R~: 150 WL. SL, CON R~4853 <br /> <br />CiTY JURiSDICFION~ BY DATE <br /> <br />FORM # MC 15.56 REV 4/90 OFFICE COPY <br /> <br /> <br />