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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 />The work will be performed by a rogistered builder, <br /> <br /> ;OATE~ 06/24/?4 <br /> <br /> 6~FE.,.> OR ~7346 ~b~P~N~ LOAD: <br /> <br />ADDRESS: <br /> SMALL, <br /> 884 WCODI,..ANIO DR , <br /> <br /> IHON: ..... '~7,~"' 4._4~'~ ' ~ VALUAT]:ON: <br /> <br />TYPE: PLUMBING <br /> <br />PERMIT OR APPLICATION <br /> <br />r~ES,ti~EI,t'J'I~L F'IXTUR~ NEW CONST. <br />PI..UHBIHG BASE FEE <br />PLU?4S'[NG STATE SI.II~C',,tARGE <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />OWANTI TY ANOUN'I" <br /> 22 '~)~ :L Q (ii. C~ (4 <br /> $22). <br /> <br />$134.4B <br />$.1,34.40 <br /> <br />BALANCE DUE $~,, r2!0 <br /> <br /> F AYk, l::.. EO/ll~ ORV;ELI,_E INV(, .[(,l:: NO~ ,.~S.J,].I. <br /> RECE'[VI',;D BY~ PH .......................................................... TYF'E: IN CHECK ~I:;; 0 <br /> <br />~ THIS IS NOT A PERMIT= THIS APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING HUST BE COflPLETEB. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> LL NECESSARY INFORMATION HAS BEEN PROVIDEB. <br /> <br />PLAN )':li'~"[l::[): BY ........................... DATE <br />nE~f-I(t\,~. :l.'J.~ F]:XT <br /> <br />CITY ,JURI.C)D1CTTON: BY ...................... ~SATE ............................. <br /> <br />FORM/~ MO 15-56 R~V, 4/90 <br /> <br />OFFICE COPY <br /> <br /> <br />