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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 />of a registered builder. <br /> <br /> 7492 LOFTY LOOP SE <br /> AUMSVILLE OR 97325 ! HARION COUNTYI NO , , <br /> <br />MAILING <br /> <br />7725 65TH AVE <br />SALEH OR 97;~05 SITE NUHBER-~ 73-~2518 <br />PHONE: ~90-5445 VALUATION: <br /> ~b~'RT SECT ON [TOWNSH P ' RANGE'. ~ ZONE'. ( MAP; <br /> <br />TYPE: PLU~SIH~ PERMIT OR APPLICATION HO= 9g~486~2 ~r <br /> <br />CONTRACTOR~ NO. <br />BAGHRANIAN, GOORIKH <br />7725 65TH AVE <br />SALEM OB 97305 <br />PHONE: ~90-5448 <br /> <br /> ITEM QUANTITY AMOUNT <br />WATER LINES, 1ST 100 FEET 1 $20.00 <br />PLUMBING STATE SURCHARGE $1.00 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS 'RECEIPTS <br />THIS RECEIPT <br /> <br />$21.00 <br />$0.00 <br />$21..00 <br /> <br />~BALANCE DUE $0,00 ( <br /> <br /> PAYEE:.BAGHRAMIA~, GOORt~KH '. ' RECEIPT NO: 5~922 <br /> RECEIVE~ BY: MB ~'~ . ~".~'E~ TYPE: CK CHE'GK ~: 459 <br /> ................ ~ .... :::::::::::::::::::::::: ........................ Z ...................... <br />~ THIS IS HOT A PERHIT. A REVIEW PROCESS ~HERE THE <br />FULLO~IH~ MUST ~E THE APPLICANT TO ASSURE THAT <br />LL HECESSARY IHFORH~T~OH <br /> <br />PLAN REVIEW: BY .......... DATE .............. <br />REMARKS: 100FT WATER <br /> <br />CITY JURISQICTION: BY .......... BATE <br /> <br />OFFICE COPY <br /> <br /> <br />