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MARION COUNTY BUILDING INSPECTION <br /> SENATOF~ 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 performirlg work on a property I own or occucy. <br /> I em a regiateredbuilderOR( )theauthorizedrepfesentative <br /> of a registered builder, <br /> The work will be performed by a registered builder. <br /> Other <br /> I have read and agree to the terms stated on the reverse side of <br /> <br />UA f b.: 10/Gl/gq 'T' 1ME, ~ <br /> <br /> PONERS, RICHARD <br /> <br />CONSTRUCTION TYPE: <br /> <br />CATEGORY: <br /> <br />OCCUPANC : <br /> <br />REG[OENfI.AL <br /> <br />f,)E'RJlf <br /> <br /> ---- ' OON'F~ACf CITY: UGS: ',OCCUPANT LOADI <br />OR 97342 <br />......... joE'rmiT , UO <br /> <br />MAILING ADDRESS: <br /> <br />4336 BIR~ AVE N <br />K~: [ZER 9'?303 <br />PHONE: 39[~"'2'! '1'! <br /> <br />LOT. BLOCK: <br />WIDTH: <br /> <br />TYPE: MECHANICAL <br /> <br />MAY AOON <br /> <br /> SiTE NUMBER: ]4432 <br /> VALUA'IION; <br /> <br />]1 <br /> <br /> NO i NO <br /> <br /> PER~IT OR APPLICATION NO: 35819 <br /> <br />(3ON'I'RAC'I'OR NO. <br />POWERS, RICHARD <br />41536 BIRCH AVE N <br />KEiZER 9?303 <br />PBON~: 390--2717 <br /> <br /> ITEM <br />F,Y,:~ES'f'IC I,NOOD 5'f'OV~ <br />MBCHANICAt.. BASE FEE <br />MECHANICAL Sf'A'IE SURCHARGE <br /> <br />QUANTITY AMOUN] <br /> <br /> $'10,~0 <br /> SO.SD <br /> <br />FOTAL .A.SSESSEDFEES <br />PREVIOUSR~C~IP'rs <br />THIS RECEIPT <br /> <br />$18_38 <br /> <br /> $o_oo <br /> <br /> PAYEE: PG~E}~$, RICHARD ' INVOICE NO: 37734 <br /> REC~IV~P BY; Dr,42 ' : tN C~E:CK ~: 0 <br /> <br />~ THiS iS A VALID PERMIT 180 DAYS FRO~ iTS iS~tJE DATE. IF <br />~ST~CTi~ O~ FOR A PERIOD OF 180 DA~,ORIF ~ST~CTI~ FAI~ TO ~EET ALL <br />~I~BTS OF STATE ~ ~D ~R~ ~N~ 8UILBI~'~B Z~ING OROIN~C~. THIS PEril' <br />~ALL 8BE NULL ~D ~iD. <br /> <br />REMARKS: EXISTING ~i5 <br /> <br />!.¢'{,JNAL~ E. WOODLEY, MARION CQUN'¥'Y BUILDING OFFICiAE / BY <br /> <br />FORM # MC 15.56 REV. 4/90 OFFICE COPY <br /> <br /> <br />