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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM. OREGON 9730! <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am perfor,.m?ng work on a property J owr~ or occupy, <br />I am a regi=tered builder OR the 8uthodzed representative <br /> of a registered builder, <br />The work will be prr'tOrmed by 8 regtstered builder. <br />Other <br /> <br />I have read and agree to the terms stated on the reverse side of <br />this document. <br /> <br />OWNER: TAX I=OT; } CATEGORY; <br /> BO~HLER, SI'E~EN N : RES~OE~ <br />SI~¢S ADDRESS: CS~R~ION TYPE: OGCUPANCY: <br /> <br /> ~ OCCUPANT <br /> 980 8'T'H ~'f N- ~ CONTRACT CITY; ~ UGh: LOAD: <br /> AU~V t LLE OR <br /> <br />F"O BOX 1061 <br />AUIV'rSV i LLE 9?325 <br />PHONE: 749~35~5 S~'TE NUMBER: 1443'] <br /> VALUA'f' I ~: <br /> <br />i SGabi~iSTON: ....... <br /> <br />IRRE~ LOT: i CORNER: <br /> NO ~ NO <br /> <br />FYPE: MECHANICAL PERMIT OR APPLiCAfION NO: <br /> <br />35808 <br /> <br />CON'[',RAC'f'OR, NO. <br />B~HLER, STEPHEN <br />PO BOX 1081 <br />AUMSVtLLE 9?325 <br />PHONE: '749~3525 <br /> <br /> 1TEM <br />E)OC4ES'f'tC ~000 S'FOV~ <br />MECHANICAL. BASE FEE <br />MECHANICAL ~f'A1E SURCHARGE <br /> <br />QLIANTiTY AMOUN~ <br /> $'?.50 <br /> <br /> $0.88 <br /> <br />:PR~WIf.,XJ~RECEiP'f'$ <br />'f'HJ$ RECE:JPT <br /> <br />$18,38 <br /> <br /> $0.oo <br /> <br />BAL.EC4CE DUE: $0_ 00 <br /> <br /> PAYEE:: J NVO J.C~; NO: <br /> RECEIVED BY: fgM2 T'YPE; CHECK ~: <br />a: THIS IS A VALID PERI, IT * : THIS~PE~IT~:~i~ 180 ~ F~ IT~ i~E DATE. IF <br />~ST~CTi~ C~ ~R A ~R[~ OF 180:.~: OR IF.~T~CT[~ FAI~ TO ~EET ALL <br />~[RE~TS 0F STATE ~ ~D:~R[~ ~NTY 8U[LDING ~O Z~ING ORDiN~C~. THI~ PEril' <br />~ALL BEdE NULL ~0 ~[0 <br /> <br />REMARKS; iNSTALL U~ED NS <br /> <br />L)ONAL. D P,,', ~OODLEY, ~4ARZON COUNTY BUILDING OFEJCiAL / BY <br /> <br />~o~ ,~ uc ~-~ R~v, ,~/,o OFFICE COPY <br /> <br /> <br />