Laserfiche WebLink
MARION COUNTY' BUILDING INSPECTION <br />SENATOR SLDG 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 6wn or O¢gupy <br /> I am a registered builder OR ( ) the authorized representative SIGNATURE OF APPLICANT <br /> of a registered builder.. <br /> The work will be pedormed by ~ fegirered bu~der <br /> Other <br /> I hove read and agree fo the terms stated on the reverse Side of CATE <br /> this document <br /> <br /> DA'rE:. 9~Z1.3X91 'fiNE; 12:00;;85 <br />~itI~-AbB"~Es?AT~''[EW~En ...................................... ¢~-Rx' .......... ['~&~gr"UcrioN i';(~EJ¢ fXX LOT ...... ....... 562'74-000 , <br /> <br /> 9624 MiLL CREEK <br />AUr,~VILLE <br /> <br /> ~;~ ....................... <br /> <br />SA.r4~ <br /> <br />PHONE: 749~2846 <br /> <br /> 5tI'E NUMBER; 14110 <br /> VALUATION: <br />iSECT ON ! TOWNSHI'P ~A~G~ T zo'~ ~M~ <br /> <br /> ~. ....... ) ...... <br /> <br />TYPf~: ~IECHAN i GAL <br /> <br />CON1 RAC1OR, NO. <br />BATES, GARY <br /> <br />PEF~iF OR APPLiCAFiC4W NO: <br /> <br />9035143 <br /> <br />PHONE: '749-2846 <br /> <br /> iIEM <br />0OM E~0"I~T F/~N5 & DRYER VENTS <br />NECHANICAL BA~E FEE <br />MECHA.NICC~L ~FAFE SURC,'HAF~E <br /> <br />lO'fAL ~ED FEES <br />pREWtEX~S RECEIPTS <br />THiS RECEiP1 <br /> <br />BALANCE DUE <br /> <br />QUAN f IIY <br /> 3 <br /> <br />$9.oo <br />$~0_00 <br />$0.95 <br /> <br />$19.95 <br />$o.0o <br />$19.95 <br /> <br /> $o_00 <br /> <br /> PAYEE.: BALE,5', GARy INVOICE NO: 3'7050 <br /> RECEIVED BY: DB ........ Z~_...._ TYPE: IN CHECK ~t: O <br /> <br />~LL~IN~ ~ST ~E ~PLETED+ IT l~ ~HE .R~SIBILI~ OF THE APPLi~T TO ~RE THAT <br /> <br /> P~ REVIEW: BY ................. DATE ....... ~__~,,,.,.Z CJ'fY JURiSDicTi~: BY <br /> RE~RKS~ VI FN <br /> <br />.o... uc ~ sst, R~ ~ OF FICE COPY <br /> <br /> <br />