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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 />~ am performing work on ~ property I own or occupy· <br />lama registered builder OR[ )thead~horized representative <br />of a registered builder. <br />lhe work wi)) be performed by a registered builder, <br />Other <br />I have read and agree to the terms stated on the reverse side of <br />this documertt. <br /> <br />COX, OARVIN <br /> <br /> 740 M~IN ST .... CONT~A~CT CITY: , UGB: 0~dUPANT LOAD: <br />AUHSVIL. LE OR AUMSVI ~E NO ' <br /> <br /> SITE NUMBER; 92-04;~2~ <br /> PHONE: <br /> 749'- 22,.,7 VALUATION: <br /> <br />[ I~OT; : BLOCK; SECTION: TOWNSHIP: RANeE: MAP: <br /> <br /> ; A~A~ ::'~i'+A: <br />;WIDTH; D~PTH; <br /> <br />TYPE= MECHANICAL PERMIT OR APPLICATION NO: 44556 <br /> <br />CONTRACTOR, NO. <br />COX OARVIN <br /> <br />PHONE: 749-2237 <br /> <br /> iTEM <br />BAS CONMECTION <br />MECBANICAL BASE FEE <br />MECHANICAL, STATE SURCHARGE <br /> <br />QUANTITY AMOUNT <br /> 1, $2.00 <br /> $10-00 <br /> $0.60 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$.1.2_60 <br /> SD..00 <br />$L2.60 <br /> <br />BALANCE DUE 'SO .. O0 <br /> <br />PAYEE: COX, OARXlN INVOICE Mo: 44, 12 <br />RECEIVEO BY: o12 ................................................... TYPE: CK CHECK ¢: 5060 <br /> <br />· THIS IS A VALID PERMIT * THIS PERMIT EXPIRES 180 DAYS FROM ITS ISSUE DATE. IF <br />CONSTRUCTION CEASES FOR A PERIOD OF lBO DAYS, OR IF CONSTRUCTION FAILS TO MEET ALL <br />EQUIREMENTS OF STATE LAWS AND MARION COUNTY BUILDING AND ZONING ORDINANCES, THIS PERHIT <br />SALL BECOME MULL AND VOID. <br /> <br />REMARKS: BAS CON ONLY FOR STOVE' <br /> <br />OONALO E.. ~OODL. EY, MARION CODNTY BUILDING OFFICIAL / BY <br /> <br /> OFFICE COPY <br />FORM # MC ~5-56 REV. 4/~0 <br /> <br /> <br />