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MARION COUNTY BUILDING IINSPECTION <br />SENATOR BLDG. NO, 225 <br />220 HIGH STREE? NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-8147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />Other. <br />I have read and agree to the terms stated on the reverse side of <br />this document. <br /> <br /> OATE: 09/29/?2 TIME: 10:42:33 <br /> <br />I am performing work on aproperly I own or occupy. <br />I am & registered builder OR the authorized representative <br /> of a re~'¢stered builder, <br />The work will be performed by a registered builder, <br /> <br />DATE; <br /> <br />'~ltus ADDnESS: , CONS'r~UC¢~ ¥'¢¢E: !OCCuPANcY: <br /> <br /> 11592 BLUE HERON LN NE <br /> AUROR~ 0R 97002 ;R~F~T¢ONTY'~ ~; OCCOPANT~O*O: <br /> <br />:MAILING ADDgESS; ~Oel)IVI'SK~N: ' <br /> <br />RHONE: 678-2460 <br /> <br />SITE NUMBER: 92-03479 <br />VALUATION: <br /> <br />TYPE: HECHANICAL <br /> <br />CONTRACTOR, NO. <br />LEWIS, RAY <br /> <br />PERMIT OR APPLICATION NO: 42877 <br /> <br />PHONE: 678-2460 <br /> <br /> ITEM <br />OONESTIC WOOD STOVE <br />MECHANICAL BASE FEE <br />MECHANICAL STATE SURCHARGE <br /> <br />TOTAL ASSESSED FEEB <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY AMOUNI' <br /> 1 $7.50 <br /> $:LO-O0 <br /> $0.88 <br /> <br />$18.58 <br /> SO.OD <br /> <br />BALANCE DUE SO.OD <br /> <br /> PAYEE: LEWIS, RAY RECEIPT NO: 44947 <br /> RECEIYEO BY: DM2 ...................................... TYPE: CK CHECK ~: 2129 <br /> <br />* THiS IS A VALID PERMIT * THIS PERMIT EXPIRES 180 DAYS FROM ITS iSSUE DATE. IF <br />CONSTRUCTION CEASES FOR A PERIOD OF ~80 DRYS, OR IF COHSTRUCTIO~ FAILS TO MEET ~LL <br />EQU~EEMENTS OF STATE LR~S ~ND MRRZON COUNTY 8UILOIN6 RflD ZOHIN6 ORDINANCES, THIS PERMIT <br />S~LL BECOHE NULL AND VOID. <br /> <br /> REHARKS: ~OOD STOVE ~ ~ <br /> DONALD E,, WOODLEY, HARION COUNTY BUILDING OFFICIAl_ / BY ................................................. ~ <br /> <br /> OFFICE COPY <br />FORM # MC 15,56 REV. 4/90 <br /> <br /> <br />