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220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> : rHONE 588-5147 <br />CODE-A-PHONE 4:30 P.M.- 8;00 A;M. <br /> <br />of a registered builder. <br />The work will be pedormed by a registered builder, <br />Other. <br /> <br />I have read and agree to the terms stated on the reverse 8ida of <br />this document. <br /> <br />~ PL <br />SUBLINI~ O~ 97385 <br />US~ O~ BUu,'DIN~: ................. <br /> <br /> TAX LOT <br /> CONSTRUCTION TYPE <br /> CONTRACT CITY~ <br /> <br />SUBI,,,IM,ITY <br /> <br />SUBDIVISION; <br /> <br />PO BOX 188 <br />SUBLIMITY OR 97383 <br />PHONE: 769-7364 <br /> <br /> LOT' 8LOCK' <br /> <br />8'1 100 <br /> <br />SECTION TOWNSHIP. <br />t, REA 34 UNITS <br /> 8.1 O0 ~ SF <br /> <br />SITE NU~ER~ <br /> VALUATION <br /> RANGE <br /> <br />UGB: <br /> <br /> NO <br /> <br />MORNING CREST ADD III <br /> 9160 <br /> <br /> NO YES <br /> <br />CATEGORY <br /> <br /> RESIDENTIAL <br />OCCUPANCY <br /> <br />OCCUPANT LOAB: <br /> <br />TYPE: PLUMBING <br /> <br />PERNIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. 28638 <br />T.G.NICHOL PLUMBING, INC <br />P,O.BOX 166 <br />AUNSVILLE, OR 97325 <br />PHONE: 749-2071 <br /> <br /> ITF~I <br />RESIDENTIAL FIXTURE. NEN CONST. <br />HATER LINES, 1ST 100 FEET <br />SE!NER LINE.S, 1ST 100 FEET <br />PLUNBING BASE FEE <br />FLEET SURCHARGE -ZONE 4 <br />PLUMBING STATE SURCHARGE <br /> <br />21453 <br /> <br />QUANTITY ANOUNT <br />9 $81.00 <br />1 $20.00 <br />1 $30.00 <br /> $20.00 <br /> $5.12 <br /> $7.55 <br /> <br /> TOTAL ASSESSED FEES $163.67 <br /> PREVIOUS RECEIPTS $0. O0 <br /> THIS RECEIPT $163.67 <br /> BALANCE DUE $0.00 <br /> PAYEE: TON OORAN INVOICE NO: 22789 <br /> RECEIVED BY: ~ - ............ .... ......... TYPE: IN CHECK ~: 0 <br /> * THIE, IS A VALID PER~'I'T * THiS:PF_~I'T EXP'rRES '180 DAYS FROIvl ITS f,SSUE DATE. l'F <br />C~NSTRUCT]'ON CF.~ FOR A PERTOD OF :180 DAYS, OR IF COI~CTION FAILS TO I~IEET ALL <br /> <br />EiHALL BIBCOI~IE <br /> <br />REtV~ARKS: 9 FIX HL SL <br /> <br />DONALD E. WOODLEY. MARION COUNTY BUILDING OFFICIAL /8~Y <br /> <br />~OR~¢ ,, MC ,~,.~,,~ .,v ~/e7 OFFICE COPY <br /> <br /> <br />