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MARION COUNTY BUILDING INSPECTION <br />SENATOR E~LDG, 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 />of a registered builder, <br /> <br />I hev(~ reed and egree to [he term8 stated on the reverse side of <br />this document. <br /> <br />SIGNATURE OF APPLICANT: <br /> DATE; <br /> <br />ow~'fE: 05/14/91 'liME: 15:15:59 <br /> GENTZLER, DON <br /> <br />!TAX LOT: <br /> <br /> ¢ONS~RUGTI~ TYPE: <br /> <br />RES J( DEN 'f [ A L <br /> <br /> 10523 POR'fER RO <br />AU~SVI LLE OR <br /> <br />10683 PDRTER RD SE <br />AUf~SVILLE <br />PHONC: ?49-2649 <br /> <br />LOT: 8LOCK: <br /> <br />SITE NUIV~ER: 10593 <br />VALUA'r ! ON: <br /> <br />WIDTH: DEPTH: <br /> <br />ARBA: 6 UNITS: ~ i ~IR~EG LOT; ~1~ CORNER; <br /> <br />rYPE: MEC~ANiCAL PER, Il' OR APPLiCATiON NO: <br /> <br />31833 <br /> <br />o%w'r~c'roe. NO. <br />GEN'f'ZLER, DON <br />10683 PORTER RD SE <br />AU~SVtLLE <br />PHONE: ?49-2840 <br /> <br />GAS CONNEC'flON <br />FORC AIR F~RN 300090 BTU OR <br />MEOr-t/~tCALELASE FEE <br />MECHANICAL STATE E¢JRCHARGE <br /> <br />TOTALA,%SEEcSED FEES <br />PREVIOUS RECEIPT5 <br />THiS RECEIPT <br /> <br />QUANTITY ANOUNT <br />1 $2.00 <br />I $6.00 <br /> $10.00 <br /> $0.90 <br /> <br />~18.90 <br /> 18.90 <br /> $0.00 <br /> <br />BALANCE 0UE $0.00 <br /> <br />RECEIPT NO: <br />CHECK ~: 0 <br /> <br />PAYEE: <br />RECEIVED BY: PB TYPE: <br /> <br />* THIS 1,~ A VALIO PERIRIT :~ THIS PER~IT EXPIRE~ 180 ~ ~ ITS ISE ~TE. IF <br />~T~Tl~ ~ ~R A ~I~ ~ 180 ~, ~ IF ~T~Tl~ FAI~ TO ~ ALL <br />~I~TS ~ STATE ~ ~O ~I~ ~ ~[LO[~ ~O Z~[~ ~DiN~, THiG ~IT <br />~ALL 8~E NULL ~D ~ID. <br /> <br />RF~ARKS: ~ LN · FURN R~35'F7 <br /> <br />DONALD E. ~G,YJDLEY, MARION COUN1'Y BUILDING OFFICIAL / BY <br /> <br /> OFFICE COPY <br />FORM # MC 15-56 R~V. <br /> <br /> <br />