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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 22,5 <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 />I am a registered builder OR( )tlleauthorized representative <br />of a regis ered builde <br />'fha work will be performed by a registered builder <br />Other <br />I have read and agree to the terms stated on tho reverse aide of <br /> <br />DATE: <br /> <br /> DATE: 09/27/91 <br />OWNER: <br /> <br /> JOHANn, GARY <br /> <br />1,4E~ I (JEN l 1AL. <br /> <br /> 10653 EI'qLEN ROAO NE <br />AU RORA OR 9 ? 002 <br /> <br />, ~ONTRACT C~TY; DGB; OCCUPANT LOAF): <br /> <br />Uo/ 921-- 9 <br /> <br />SUBDIVISION: <br /> <br />RHONE t <br /> <br /> VALUATION: <br />RANGE: ZONE: <br /> <br />MAP: <br /> <br />NO : NO <br /> <br />'fYPb: MECH~ICAL <br /> <br />CONTRAC'¥'OR, NO_ <br />J~4ANFJ3N, GARY <br /> <br />PERMiI' OR APPLICATION NO: 25591 <br /> <br />PHONE <br /> <br /> llf~ <br />BO~lf~C [.¢300 STOVE <br />MECHAN~f,:,%AL BASE FEE <br />MECHANICAL STATE SURCHARGE <br /> <br />QUANIT'I'f'Y AMOUNT <br /> 1 $?. 5o <br /> $10_00 <br /> <br />$18,38 <br /> <br />PAYEE: JOHANn, GARY <br /> <br /> TOTAbA.~E~ED FEES <br /> PRE~OMS RECEiplfS <br /> THIS RECEIPT <br /> <br />~ALANCEDUE <br /> <br /> , RECEIPT NO: <br /> <br />$o,oo <br /> <br />3?504 <br /> <br /> RECE ED ~Y: 0~42 ~ OK CHECK ~:: 1113 <br /> <br /> THiS IS A VALID PE~IT ~ THIS :E~IT ~I~ 180 ~ F~ IT5 I~E ~TE_ iF <br />~ST~CTI~ C~ ~R A ~RI~ OF,180 ~, OR iF ~T~CTI~ FAI~ TO ~E~T ALE <br />R~iR~T~ OF STATE ~ ~D ~RI~ ~N~ BUiLDI~ ~D Z~ING OROIN~C~. THIS ~IT <br />~ALL ~E NULL ~O ~[O. <br /> <br />RfS~ARKS: E~( Jls'r i NG ~ R~3618 <br />L)ONALD E. ~3ODLBY, MARION COUNTY BUILDING OFFICIAL / BY ........................................................................~ <br /> <br /> <br />