Laserfiche WebLink
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 a eR s ered builder OR ( ) he authorized ep,'esentative SIGNATURE OF APPL CANT: <br /> <br />OWNeR: TAX LOT'. : ~ATEGOHy: <br /> DATE: 8,,'~1._,~1,~ 'F~ME: 10:58:09 <br /> <br />SITUS Ao~Tt. ISHEZ~ 9RN C6~f~Odf~bN TYPE'. O~J~'r;~L. <br /> <br /> :1.08;~1 ARNDT RD <br />USE OF 9U~LD~L'~,!R8 <br /> <br /> NE <br />OR 97882 <br /> <br />CONTRACT CITY: uGS; <br /> <br />MAR ION COUNTY NQ <br /> <br /> SITE NUMBER: 93-0181~4 <br /> PHONE: 678-2660 V~!~,UAT ION: <br />LOT: BLOCK; SECTION; ~(~W~aHI¢: RANGE: 701~i MARl <br /> <br />TYPE: MECHANICAL <br /> <br />COMTRACTOR~ N¢. <br />flARTUSHEZ~ DAN <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />9047299 <br /> <br />F'HONE: 678-2660 <br /> <br /> ITEM <br />DOMESTIC RANI..E HOOD <br />DOM EXHST FANS & DRYER vF:NTS <br />APPLIANCE OR ACCESSORY (NOT COVERED) <br />MECHANICAL BASE FEE_ <br />MECHANICAL STATE SURCHARGE <br /> <br />TOTAL ASSESSED FEES <br />FRE~IOUS RECEIPTS <br />TH:£S RECEIPT <br /> <br />ti(JAN ?' ~ T Y A blOIJFfT <br />:L $4.50 <br />1 $3.80 <br />I $4,, 50 <br /> <br />$?;,, 18 <br /> $8.80 <br />$ ~. 3.10 <br /> <br />BAI,,,ANCI~i DUE ,$0.00 <br /> <br /> PAYEE: MARTLJSHEZ, DAN "' ..... '-' <br /> I~:CE].i-[ I,]0: 49568 <br /> RECEIVED BY: F'M ..................................................... TYPE: CK CHECK ~: 2409 <br /> <br />* THIS IS NOT A PERMIT. THIS APPLICATION MUST 60 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 PROVIDED. <br /> <br />PLAN '- :-" <br /> RE, VIL. W,, BY DATE <br />CITY .,IUI:ZI; SD ]: C T I OFI?~ ............ D~TFf ................... <br />REMARKS: EXHTS,, DLICT EXTEfqS~ON BU:~72St~ ...... <br /> <br /> OFFICE COPY <br />FORM # MC 15-~ REV. 4/90 <br /> <br /> <br />