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MARION COUNTY BUILDING INSPECTION <br />SENATOR 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 have read and agree to the terms stated On tho reverse side of <br /> th~s document. <br /> <br /> BATE: 12/04/92.. rlHE: 11:19:29 <br />OWNER'. <br /> TOt~NSEND, OI×IE <br />51TUS ADDRESS: <br /> <br /> ~W~STER~A OR NE <br /> AURORA OR 97002 <br /> <br />MAIliNG ADDRESS: <br /> <br /> OATS; <br /> <br />20NSTRUOTION TYPE <br /> <br />CONTRACT CITY: <br />MARION COUNTY <br /> <br />JGB. <br /> <br /> '40 <br /> <br />CATEGORY: <br /> <br /> RESIDEN[ <br />DCCUPANOY <br /> <br />OCCUPANT LOA£ <br /> <br />LOT: <br /> <br />WIDTH: <br /> <br />PHONE: 678-2429 <br /> <br /> SLO~: <br /> <br />SITE NUMBER: <br />VALUATION: <br /> <br />SECTIdN; TO~VN~H~: , RANGE: <br /> <br />92-04185 <br /> <br />ZONE <br /> <br />DEPTH: AREA: UNITS: IRRP~. LOTi ; CbRN~R <br /> NO NO <br /> <br />MAP; <br /> <br />TYPE: MECHANICAL PERMIT OR APPLICATION NO: 9044259 <br /> <br />CONTRACTOR, NO. 14008 <br />ROTH ZACHERY HEATING INC <br />593 SE iST AVE <br />CANDY, 97013 <br />PHONE: 266-.1247 <br /> <br />Il'EH <br />GAS CONNECTION <br />FORD AIR FURNACE UNDER 100000 BTU <br />GAS WATER HEATER <br />MECHANICAL BASE FEE <br />MECHANICAL STATE SURCHARGE <br /> <br />QUANTITY AHOUNF <br />1 $2.OD <br />Z $6_00 <br />i $7.50 <br /> $10.00 <br /> $1.28 <br /> <br />TOTAl_ ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$26.78 <br /> $0.00 <br />$26.78 <br /> <br />BALANCE DUE $0-00 <br /> <br /> PAYEE: ROTH ZACRERY HEATING INC .¢l~r/ RECEIPT NO: , 46409 <br /> RECEIVED BY: LD ..... . _~j: TYPE: OK CHECK ~: .K~ (,5¢~J~ <br />.......................... ~__~__~-~%~_ ~ ............................................................................ <br /> <br />$ THIS IS NOT A PERMIT. THIS APPLICATION flUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST BE COMPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />LL NECESSARY INFORMATION HAS BEEN PROVIOED. <br /> <br />PLAN REVIEW: BY DATE <br />CITY J~RISOIOTIORT"'~ ...... O~Y~! ............. <br />REMARKS; FURN GAS WH~-~-OONN <br /> <br /> OFFICE COPY <br />FORM # MD 15-56 REV. 4/90 <br /> <br /> <br />