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MARION COUNTY BUILDING INSPECTION <br />SENATOI~ BLOG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, O~EGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />lamaregisteredbuilderOR( ) the authorized representative <br /> <br />I have read and agree [o the term8 stated on the reverse side of <br /> <br />SIGNATURE OF APPLICANT: <br /> BATE: <br /> <br />OWNf~A'f'E t 09/19/91 TINE; <br /> <br /> JBN~r¢~, A~'NOLO H <br />S~TUS ADDRESS: <br /> <br />15.* 18.'57 <br /> <br />RE$iOEN'IIAL <br /> <br /> ' CONTRACT CITY: <br /> 390 DE'rRO['f' RD -- <br /> 0ErROIT OR 9'7345 <br />USE OF BU~LDING: '0ETROJT <br /> <br />JGB <br /> <br />NO <br /> <br />DCCUPANT LOAD: <br /> <br /> NO OF BEDROOMS <br /> <br />MAILING ADDBESS ~ SUBDIVISION' <br /> <br />P.O. BOX 556 <br />DETROIT, ORE 97342 <br />PHONE: 538-3869 <br /> <br />~17'~ NUMBER: 9125 <br />VALUATiON~ <br />RANGE ZONE <br /> <br />RREG LOT <br /> <br />CORNER <br /> <br /> NO <br /> <br />TYPE: MECHANICAL <br /> <br />C0~TRAC'fOR, NO. <br />JENSEN, ARtNOLD h <br />P.O. BOX 558 <br />0EII'Ro['r, ORE 9?342 <br />PHONE: 538-3869 <br /> <br /> i'f'EN <br />~f.:.~Es'rlc ~OOD srovE <br />M~G~ANICAI BA~E FEE <br />MEC~/~ICAL S'f'A'[E SUR'%,iHARGE <br /> <br />PAYEE; JENSEAI, ARNOLD H <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />TOTAL ~ED <br />PR~¥iOU$ RECEIPTS <br />THI~ RECEIPT <br /> <br />QUANTITY A~4OUN'f <br /> $7.50 <br /> <br /> $0.88 <br /> <br />$18.38 <br /> $o.oo <br />$18.38 <br /> <br />BALANCE DUE $0.00 ~I <br /> <br />INVO f CE NO: 37190 <br /> <br /> RECEIVED BY: 0~12 ....................... ...................................... 'TYPE: fN CHECK ~.* 0 <br /> <br />~T~Tt~ C~ ~R A PER/OD ~ 180 ~, OR IF ~T~CTZ~ FAt~ TO ~ET ALL <br />~ZR~TS OF STATE ~ ~D <br />~ALL B~E NULL ~D <br /> <br />R~RKS: NOOO STOVE j~ <br />f.~.)NALD E. ~¢OODLEY, r4ARION COUNTY BU]Lg[NG O?FiCiAL / BY ........................................................... ~i.~ ............................................ <br /> <br />FO~M # MC 15-56 REV. ~/90 OFFICE COPY <br /> <br /> <br />