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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:$0 <br /> 24 HOUR CODE-A-PHONE: 588-7904 // <br />I am a registered builder OR ( ) the ~uthodzed regresentatlve SIGNATURE OF APPLICANT: .......... /.~ .,...*:.~_ L.~ '~ ............. <br />of a registered builder, <br /> <br /> i <br /> ROBEL. L0, ROBERT & GA:B_ i <br />: si'r0S .~C,D~S~i .................................... ..................... ! 8~LJ~';4~d~i ' <br /> <br /> 87;~4 SHAW SLlUARE RD =,- 'bd'kifF~%<~--~i¥~:-' ....... <br /> AUHSVILLE 0R 97S25 MARION (..0UNT~ N0 <br /> .......... ~ .............................. <br /> <br /> ~777 .................................................................................. <br /> <br /> SITE NUMBER: ?3-82771 ,, <br /> PHONE: ;~4-1655 VALUATION: , <br /> <br />i'L.~;¢ BLO~N SECTON ~ - - ~T~¢ .... R~NG~~ ~'~-~ .......... ~-~ <br />~W DTH /[OEPTH ~ AREA ~ UN TS ';~ IRREG.NO LOT: ~ CORNER:NO ' <br /> <br />TYPE: PLUHBING PERMIT OR APPLICATION HO: <br />CONTRACTOR, MO. 4~162 <br />Da~iel More'b~ <br />524~ SuYmyview Rd NE <br />SaleM.¢ <br />PHONE: <br /> <br /> ITEM <br />WATER LINES~ 1ST 188 PEET <br />WATER LINE~, E~. A~BL. 188 FEET <br />SEWER LINES, 1ST 18~ FEET <br />PLUMBING STATE SU~CHA~CE <br /> <br />PAYEE: NORRETT CONSTRUCTIO~ <br /> <br />9849899 <br /> <br />TOTAL. ASSESSED FEES <br />PREV~OO~ RECEIPTS <br />THIS .RECEIPT <br /> <br />BALANCE'QUE <br /> <br />QUANTITY AMOUNT <br />I $20.06 <br />2 $36.60 <br />1 $30.60 <br /> $4,,60 <br /> <br />$84,,00 <br /> $0.06 <br />$84.66 <br /> <br />$0.,06 <br /> <br />RECEIPT NO: 51441 <br /> <br /> RECEIVED BY: PM ..................................... TYF'E: CK CI.{ECK ~: 1535 <br /> <br />$ THIS IS NOT A PERNIT. THIS APPL.ICATION,,MUST ~O TNROU~ A REVIEW PROCESS WHERE THE <br />FOLLOWIN& NUST BE COHPLETE~.,, ~T IS THE 'RESPOHS~B~LITY OFTHE APPLICANT TO ASSURE THAT <br /> LL NECESSARY INFORNATION NAS BEEN PROVIDED; <br /> <br />F'LAN REVIEW: BY .................. <br />REMARKS: WL~ SI. <br /> <br />DATE ............... <br /> <br />CITY..JURISDICT:[0N: <br /> <br />BY .................. DATE .................... <br /> <br />FORM # MC 15.56 Rb~,', 4/9O <br /> <br />OFFICE COPY <br /> <br /> <br />