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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 /> am per orming work on a property l own or occupy. ~ <br />I em a registered builder OR ) the 8uthorized ¢eoresentetive SIGNA'rURE OF APPLICANT: . .. ,~,,¢~ .. <br /> <br />Other <br /> DATE ~/~ <br /> <br />oW~E~'. T) A -£ E',; ~ .... <br /> <br />; Situ~ Ab~ssr~q,¢ JOE CO~-TYPE: <br /> <br /> 11656 F'~LCON <br /> <br />USE OF BUILDING; <br /> <br />8EOROOMS: , <br /> <br /> ...... CENT~4OR¥ ' HE~ D-OQ~ <br />20 WALKi[Nf; WOOD DR <br />LAKE OSWE[',O, OR 97~5 ~A~: <br />PHONE: 6~6-..7918 <br /> <br /> 8,p <br /> <br />TYPE: PLUMBIN~ <br /> <br />PERMIT OR APPLICATION <br /> <br />CONTRACTOR,~ MO. <br />(;F~EEI'I~ .JOE <br />20 WALKIMG WOOD DR <br />[;AKE OSWE(;S,, OR ?7835 <br />F HONE: 6S6-7918 <br /> <br /> ITEM <br />WAFER LINE.S.. 1ST ].80 FEET <br />W~,A'fER LINES;, EA. AiODL. 100 FEET <br />FL, UHBINO BASE FlEE <br />PI,,,OH3ING STATE SORCHARI;E <br /> <br />TOTAL ASSESSED FEES <br />PREVI,O, OS REC, E PTS <br />TMIS kECE];PT <br /> <br />Z4ALANCE ])lie <br /> <br />QUANI'ITY AMOUNT <br /> <br /> $20,, ~0 <br /> $2,, 75 <br /> <br /> $57.75 <br /> <br /> F'AYEE: F'ARKIFI IEI_.ECTRZC ZNC RECEII~T M0: 48149 <br /> RECEIVED BY: F'H TYPE: CK CHECI~ ,~: 1474 <br />* THIS IS NOT A PERMIT. THIS APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWINS MUST BE COMPLETE9, IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> LL NECESSARY INFORMATION HAS BEEN PROVIDED. <br /> <br />F'LAN F~EVIEW: BY ......................... DATE .................... <br />REHARKS: WL,,¢ SI.. <br /> <br />CITY JURISDIC'f'ION: BY ........................ DATE ..................... <br /> <br />FORM # MC 15-56 REV, 4/~0 OFFICE COPY <br /> <br /> <br />