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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />~..0 H¢-,~'t STREET NE <br /> S~(LEM, OREGON 97301 <br /> <br /> PHONE 588-$147 <br />CODE-A-PHONE 4:30 RM. - 8:00 A,M, <br /> <br />f am performing work on a property I own or occupy. <br />I ar'h r.t registered builder OR the aLEhorized roFresentative <br /> <br />Otbor <br /> <br />I have read and ~groe to the terms stated on the reverse side of <br />this document. <br /> <br />SIGNATURE O¢ APPLICANT~ <br /> <br /> DATE: <br /> <br />HERRIN, TR~IE~EY, MELTON LEAS <br /> <br /> TAX LOT: CATEGORY: <br /> RESIDENTIAL <br /> CONSTFIUCTTON TYPE'. OCCUPANCY: <br /> <br /> CONTRACT ¢ITY~ tJGB: OCCUPANT LOAD: <br /> <br />MARION COUNTY NO <br /> NO. OF BEPROOMS <br /> <br /> 12473 FRY RD NE <br />AURORA OR 97002 <br /> <br />USE OF BUILDING: <br /> <br />MAILING ADDRESS: <br /> <br />SUBDIVISIONz <br /> <br />12475 FRY ROAD NE <br />AURORA <br />PHONE: 6?8-5494 <br /> <br /> SITE NUMBER: <br /> VALUATION: <br /> <br />21 4S <br />0.88 AC NO <br /> <br />WIDTN: , DEPTHZ <br /> <br /> 48?5 <br />ZONE; MAP: <br /> EFU 8 <br />NO <br /> <br />'TYPE: PLUMBING PERMIT OR APPLICATION NO: 20189 <br /> <br />CONTRACTOR. NO. <br />HERRIN, TRESSIE/MOONEY, MELTON <br />12475 FRY ROAD NE <br />AURORA <br />PHONE: 678-5494 <br /> <br /> ITEM <br />rclOSILE HONE SENER AND WATER CONNECTION <br />FLEET SURCHARGE -ZONE 6 <br />PLUMBING STATE SURCHARGE <br /> <br />PAYEE: <br />RECEIVED BY: PR <br /> <br />QUANTITY AIvlOUNT <br /> I $25.00 <br /> $7.68 <br /> 1.25 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$33.93 <br />$33.93 <br /> $o_oo <br /> <br />BAL,,tClOE DUE $0.00 <br /> <br /> RECEIPT NO: <br />FYPE: CHECK ~: 0 <br /> <br />REfvtARKS: CONN R~2465 <br /> <br />OONALD E. WOODLEY, i'4ARION COUNTY BUILDING OFFICIAL / BY <br /> <br />~ THIS IS A VALID PERMIT ~ THIS PERMIT EXPIRES 180 DAYS FRO~ IT~ IS~]UE DATE. IF <br />CONSTRUCTiON OF_A~q FOR A P£RIOD OF 180 DAYS, OR IF(~TRUOTION FAILS TO MF~ALL <br />REQUIRIB~IENT~ OF STATE ~ AND MARION OOUNTY BUILDING AND ZONING ORDINANCES, THIS PERMIT <br />SHALL B~I2OME NULL ANDVOID+ <br /> <br />FORM ¢¢ MC 15-56 REV 11/88 OFFICE COPY <br /> <br /> <br />