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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 am performing work Or~ ~t property I own or o¢oupy. <br /> <br />Other <br /> <br />SIGNATURE OF APPLICANT: <br /> DATE: <br /> <br /> I)A'f E,~ 10/:1,:t/73 T:rME: ?: %8:22 <br />OWNER: TAX LOT; CATEGORY: <br /> HALL,, GENE RESI DENI"IAL <br />S~TLJS ADDRESS: ~TR'UC~i~ N TYPE~ OCCUPANCY: <br /> <br />AUNSVlLLE415 CLEVELAND OR 97325-- ..... CAO~i_c~ <br /> <br />PHONE: <br /> <br />SiTE NUNBER: <br />VALUATION: <br /> <br />8LOCK: <br /> <br />AREA: j UNITS: , IRREG, LOT; CORNER; <br /> NO ' NO <br /> <br />TYPE: HECNANICAL PERNiT UR APPLICATION NO: 58627 <br /> <br />CONTRACTOR, NO. 3B9~ <br />Gera].d 6 Nali <br />16972 Fern Ridge Rd <br />Stay~ot~ 97~8~0888 <br />PHONE: 7~?-5&28 <br /> <br /> ITEM <br />GAS CONNECTION <br />FORD AIR FURNACE UNDER 188888 BTU <br />DOMESTIC WOOD STOVE <br />MECHANICAl. BASE FEE <br />MECHANICAL STATE SURCHARGE <br /> <br />QUANTITY AHOUNT <br />2 $4.88 <br />1 <br />I $7.58 <br /> $18.00 <br /> $1.38 <br /> <br />TOTAL ASSESSES FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$28.88 <br /> <br />$28.88 <br /> <br />BALANCE DUE $0.00 <br /> <br /> PAYEE Gerald G ~¢~11 h'"2 IN¥OICE NO: . 5302~ <br /> RECEIVED BY: MB._~:~__~s_~_: .... =-=:= ............. TYPE:'IN CHECK ~: 0 <br /> ~ THIS IS A VALID PERHIT · THIS PERNIT EXPIRES 188 l~fS FRON ITS ISSUE BATE. IF <br />CONSTRUCTION CEASES FOR A PERIOD OF 188 DAYS, OR IF CONSTRUCTION FAILS TO HEET ALL <br /> EDUIEEHENTS OF STATE LANS AND HARMON COUNTY ~UZLDZNG AN9 ZONZHG ORDINANCES, THIS PERHIT <br /> ALL 9ECONE NULL AND VOID. <br /> <br />REMARKS: 2/GL, WS, FURN <br /> <br />DONALD E.. WOODLEY, MARION COUNTY BUILDING OFFIC:[AL / <br /> <br />BY <br /> <br />}FF]CE COPY <br /> <br /> <br />