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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: 888-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 58~.7904 <br /> <br />of e regi~lered builder,, <br /> <br />SIGNATURE OF APPLICANT <br /> <br />LTA'I E: 12/13/90 TIME= 9~51:58 <br /> <br /> KNOX, MICHAEL ~ ~ ~INDA L <br /> <br />OCCUPANCY:: <br /> <br />Rb~IOEN I i <br /> <br /> 6691 PETE~ ~OAD <br />AU~VILLE OR 9?325 <br /> <br />S~ CONTRACT CiTY UGB: OCCUPANT LOAD <br /> MARiQN GX.~JN rY NO , <br /> <br />2 <br /> <br />10955 JA~I~ WAY DRIVE <br />AUMSVILLE 9?325 <br />PHON~: 749-2155 <br /> <br />.SE <br /> <br />P~q~IIT OR APPLICATI{~N NO~' 29127 <br /> <br />~)N'r P. AC~OR, NO. <br />KNOX, NICHAEL G ~, L[NOA L <br />10965 JAI~ES t~AY DRIVE SE <br />AUFCSV 1LLE 97325 <br />PHONE: '?~9-2155 <br /> <br /> SiTE NU~ER~ g58B <br /> VALUATION: <br /> <br />~ lW AR <br />AC YES: NO <br /> <br />WATER ,?~JPPLY: PW <br />T~T HOLE~ R~J~DY: <br />SiTE EYALUAT~ON NUN~ER: 22305 <br /> <br />~IS'FING D~iN EIELD LINES: <br />~P[[C T~K ~ED: <br />PR~WI~ NO. BED~: <br /> <br /> ! TE~ QUANT i TY APf. AJN'F <br />STANDARD ON-S] TE SYSTE~ 1 $185. O0 <br /> <br />PAYEE: <br />RECEiV~ BY: CL <br /> <br />TOTAL A,~ FEES <br />PRE'VIQU~RECEiPTS <br />THIS RECEIPT <br /> <br />$185.00 <br />$165.00 <br /> $0.oo <br /> <br />BALANCE [XJE $0.00 <br /> <br />RECEIPT NO: <br /> C~ECK ~: <br /> <br /> .... ~ .............. .... ~ ............... TYPE: 0 <br /> SEE Af'fAC~ED [X~CU~IENT FO~ RE(~UIRE~4~NTS-O~ ON-SIre ~ S~T~. <br />~ THIS iS A VALID PE~iT · THIS ~[T ~l~ 36 [~E ~TE. IF <br />~T~CTZ~ FAILS TO NEET ALL-R~tR~ ~ ~TATE ~ ~D ~[~ ~FY ~UZLD~NG ~0 <br /> <br />RgMAR~: STND SYSIE~I F~4'128 <br /> <br />D(~ALD E. NOOOL,,,Ey, MARION COUNIY BUILDING OFFICIAL / BY <br /> <br />OFFICE COPY <br /> <br /> <br />