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MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br /> <br /> 285 Church Street NE · Room 132 · Salem, Oregon 97301-3670 <br />Office Hours: 8:00-4:30 * Phone: (583) 588-5147 · 24-HR Inspection Line: (503) 588-7904 <br /> <br /> PLUHBIHG APPLICATION <br />DATE/T[HE 87/21/~5 1&:17 STATUS = APPLIE9 <br />PERMIT NO 95-14482 APPL~£D : B7/21/1~5 <br />OCCUPAHCY R-5 <br />PA~E I TO EXPIRE : ~i/17/177& <br /> <br />WO~K DESC : WI., & St,,, <br /> <br />BROSS STREET <br /> <br />FAkCEL NUMBER ','. <br />OWt,IER I,IAHF : <br /> <br />SI:'rE ADDRESS : 1.8928 MARTIN LN NE AR CITY: MARISI,[ COUNTY <br /> BUTI'EVILI..,E <br /> <br /> 400:1.8-"00g <br /> THO~PSON,¢GARY S & HOZELI_E <br /> <br />AF~PLICANT <br /> NAME <br /> ADDRESS <br /> <br />PHONE : <br /> <br />CONTRAC'I-OR <br /> PHONE <br />PLUHBER <br /> PHONE <br /> <br /> ~704[~ <br /> <br /> OCCB: <br />,LICENSE: <br /> <br />Lh'd,'[: s Desc r ip't'ion Fee <br />............... ][ ............... T¢£~;~-~xl:er llne cl,ti, t'¢.,~ ............................................................................................. <br />1 b'eet sewer line charge <br />1 State surcharge ~,,,,.0 <br />1 ~e fund ,, <br /> <br /> Assessed fees 52. <br /> Ad ~ustmen't:s ,, 00 <br /> Total fees <br /> , Total I) a X~,~en'~'s ~ ,,~ <br /> ~ i:~[eace due ~ ~ 02,, 'J8 <br /> <br /> : '(..,,,~ <br />............................. FO~ OFFZCE M~E ONLY. TR~S ~ NST R PERR[T <br /> <br /> <br />