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MARION C;OUN I Y IdUILL~INEi <br /> SENATOR BLDG. NO. 225 <br /> 220 HIGH STREET NE <br /> SALEM, OREGON 97901 <br /> <br /> PHONE: 588-5147 8:00- 4:30 <br /> 24 HOUR CODE-ArPHONE: 588-7904 <br /> <br />I am performing work on e property I own or occupy, <br />t am a registered builder OR ( ) the authorized representative <br />of a rog s ered builder, <br /> <br />AURORA OR 9?002 <br /> <br />WI L~Vi LLE, OR 9?070 <br /> r <br /> VALUA'r <br /> <br />RES I 0EN']' I AL <br /> <br />....... ~E. C4iY~-]JL. OR. A~-~,L-£~ :¥ .[ ON.. ND ¢ ......... L.. 38883- z <br /> <br />CONFRACTOR, NO. <br />L.'OUGiH~RTY, <br />29055 SW PARK WAY <br />N~LSONViLLE, OR <br />PIdONE: 682~2254 <br /> <br />9'1070 <br /> <br /> ITEM <br />WA'F~R LINES, 1S'F 100 FEET <br />SEWER LINES, 1S'f' 100 FEEl' <br />PLUFIGING STATE SURCHARGE <br /> <br />PAYEE; <br />RECEtVEO BY: CL <br /> <br />* THiS iS A VALIO <br />CON~TR~CTION CEA~I~ <br />I;~Ei;~mUiRIE~ENT~ OF STATE <br />SHALL BECOI~E NULL.AND <br /> <br /> REMARKS: WATER LINE/ <br /> <br />' DC.AiAL0 E. [NOODLEY, ~tARIOt~, <br /> <br />TO:f AL ~E~EO: P'EES. <br />P~wIr. T,,~J~.RECEip'I'S <br /> <br />QUANTITY AFK)UNf' <br />1 $20.00 <br />1 $30_00 <br /> <br />~52_50 <br /> $0.00 <br /> <br />$0. O0 <br /> <br />RECEiP]' NO: <br />CHECK ~; 0 <br /> <br /> ITE; I,~._°AJE DATE. IF <br />I-IC~ FAiL~ TO ~EET ALL <br />ZONING ORDINANCES. THi.~. PERI'liT <br /> <br />OFFICE COPY <br /> <br /> <br />