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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, 225 <br />'~20 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br />PHONE: 585-5147 8;00- 4:30 <br />24 HOUR CODE-A-PHONE: 585-7904 //.~ y ,., <br />I am performing work on a property I own or occupy, <br />J affi a regtstereO builder OR ( )the authorized representative ~IGNATURE OF APPLICANT'.~.~. <br />of ~ registered builder, <br />[~e~ork will ,~e pedo¢¢ed by a ¢e~istered builder. > ~/ --.~J" <br />;~v~o~e~;~~ agree to the terms stated on the r,verse si~e of <br /> <br />P H 0 N E s <br /> <br /> SITE NUMBER: 94-81847 <br /> VALUATION: <br />~ ~ION: ........................... RANGE r ZONE'. AP'. <br /> <br />TYPE= NECN~IHICAL PERNIT <br /> <br />CONTRACTOR~ NO, <br />HASCHE, HEL & JUDY <br /> <br />PHONE: <br /> <br /> ~TEN <br />~OH EXHST FANS & ~RYER VENTS <br />HECHANICAL 9ASE FEE <br />HECHANICAL, STATE SURCHARGE <br /> <br />QUANTITY AMOUNT <br /> <br /> $10,,00 <br /> $0.80 <br /> <br />TOTAL ASSES~E9 FEES <br />:EIPT <br /> <br />$16.80 <br /> $0,,00 <br />$t6.80 <br /> <br />PAYEE: LARRY P. KOI"_"NIG~ INC. <br />RECEIVF:D BY: MB <br /> <br /> RECEIPT NO: .~., Pg,J <br />TYPE: CK CHECK :~; 1840 <br /> <br /> ~ THIS IS NOT <br />FOLLOS[NC NUST <br /> LL NECESSARY <br /> <br /> APPLICATION. NUST GOYHROUGH A REVIEW PROCESS WHERE THE <br /> IS THE, RESPONSI'BILITY OPiTHE APPLICANT TO A~SURE THAT <br />I.{~$ BEEN-PROVI]~ED: <br /> <br />PLAN REVIEW: BY 9ATE <br />R~HARKS~ FAN/VEHT <br /> <br />~o.~ ~ MC ~S-~ ~v. ~.o OFFICE COPY <br /> <br /> <br />