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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLOG, 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 />I am a registered builder OR the authorized representative SIGNATURE OF APPLICANT[~/ ~.~,~?.~'~. <br /> <br />I have read and agree to {be terms stated o'~l" the' reverse ~ide of DATE; <br /> <br /> I CONSTRUCTION TYPE: / oCcdPANCY: <br /> <br /> ~ SITE HU~BER~ <br />PHONE: 67B,-1811 ~ VALUATION: <br /> <br />TYPE= PLUMBZNC <br /> <br />,¢.0 N 'l' R ,,A,.,{; T 0 R ,~ <br />HAt_TF;R ~ RAY <br />~,ANg <br /> <br />PHONE: 678-;I, 8:t. 1 <br /> <br />PERMIT OR APPLICATION <br /> <br /> I TE'N <br />RESIDENTIAL FIXTUFd:'.~ NFW CONST. <br />F'LUMBIN{; BAgE FEE <br />PL, UMBIHG STATE SURCHARGE <br /> <br /> QUANTITY AMOUNT <br /> <br /> $2o.oo <br /> $3.70 <br />'TOTAE:ASSESSED FEES $77.70 <br />;:PREVIOUS ~EBEIPTS <br />THIS RECEIPT $77.70 <br /> BAI,,~NCE DUE $0.00 <br /> <br /> PAYEE: HA!..TER,~ RAY <br /> RECE:[¥ED ~)Y: CL 'fYPE;: CK ;HI?CK :~ 4516 <br /> ~ THIS IS A VALID PERMIT ~ THIS PERMIT EXPIRES ,1Se DAYS FROM ITS ISSUE DATE. IF <br />CONSTRUCTION CEASES F~ FAILS TO MEET ALL <br />EaUZRE~ENTS OF STRTE <br />~LL BECOHE NULL AN9 <br /> :: <br /> <br /> REMARKS: 6 FIX :::: <br /> ~ONALD E. WOODLEY. HAR[ON COUNTY BU'i[LPIN60FFlg;~AL / BY_ ................................................................ <br /> <br /> <br />