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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 />i am performing work on a property I own or occupy <br /> <br />of a T'Ogistered buildor, <br /> <br />SAN r I AM HOMES <br /> <br /> 210 gYERGREEN DR -- 1 CONTRACT CITY <br /> AU~V/LLE OR 97325 <br />usc o~ UU~LU~N~. A,UMSV~LLD <br /> <br />UG8 <br /> <br />NO <br /> <br />F'¥ERGR.c-fc.N ~ ~I A 1 E5 <br /> <br />1157'3 MiLL CN <br />AUfVf~V l LLb, <br />F-I'iONE: ?r59-774,4 SIIE NUMBER: 13067 <br /> VALUA f iON: <br /> <br />1 <br /> <br /> NO NO <br /> <br />tYPE: PLUF4'81NG <br /> <br />PERMII OR APPLICA]-fON NO: <br /> <br /> i r EfVl <br />~O~31LE HOI~E ~E~ER AND WATER CONNECTION <br />PL.U~ ING SIA t E SUK~CHARGE <br /> <br />PAYEE: 5ANIiAIVi f'40!~IbE HOMES <br />RECE,I, VED BY: PR <br /> <br />9033143 <br /> <br />(~UANTi1Y AMC,NJN¥ <br /> $25.00 <br /> <br />FOFAL A~E~ED <br />PREVIOUS RECEIPI$ <br />THIS RECEIPt <br /> <br />$26_25 <br /> <br />BALANCE DUE $0 , O0 <br /> <br /> INVOICE NO: <br />tYPE: iN CHECK <br /> <br />:*: THIS IS NOT A PER~11T. THI~ APPLICATION r, ll.~T GO THROUGH A R~¥1~ PROCIgEx~ ~iERE THE <br />FOLLO~/ING I~UST BE COIflPLETED~ IT I~ THE. RE"::PONS[BILiTY OF THE APPLICANT TO A,T~AJRE THAT <br />ALL NF_JCI~E~:~ARff' INFORI~ATION ~ EIEIB~I PROVIDED. <br /> <br />PLAN REVIEW: BY .......... <br /> <br />R~RK~ W/S CONN ~ <br /> <br />DAI'E' .................. <br /> <br />C~IY JURISDIC'f1ON: BY DAtE <br /> <br />~o.~ ,~ ~c ~-~ ¢~,v 4~o OFFICE COPY <br /> <br /> <br />