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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 588-5147 <br /> CODE-A-PHONE 4:30 P.M. - 8:00 A.M. <br /> <br />~am performing work on a propeGfy I owr~ or occupy. <br />I am a registered builder OR the authorized representative S~GNATURE OF APPLIC <br /> <br />The work will be performed by a registered builder. <br />Other -" ._ <br />t have read and agree to the terms stated on the reverse side Of DAT=: <br />this document. <br /> <br />03/02,/90 TIME: 18=06:49 TA× LO": <br /> <br />ISBERG R V PARK 40316-935 <br /> <br />CCrcJ'flEF~C I AL · <br /> <br /> 21599 DOLORES NAY <br /> AURORA <br /> <br />USE OF BUILDtNG: <br /> <br />OR 97002 <br /> <br />NE <br /> <br />MARION COUNTY NO <br /> <br />MAILING ADDRESS: <br /> <br />SUBDIVISION: <br /> <br />SANE <br /> <br />PHONE: 8?8-2646 <br /> <br />SITE NUMBER: 9565 <br />VALUATION: <br />RANGE: ~ONE; <br /> <br />MAP: <br /> <br />DEPTH: <br /> <br />5.82000017 <br /> <br />4S IRREG. LOT: 1 ~f~ GORNbH; I O <br />AC NO NO <br /> <br />TYPE: PLUP~ING <br /> <br />CONTRACTOR, NO. <br />ISBERG R V PARK <br />SAME <br /> <br />PHONE: 878-2646 <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />9022234 <br /> <br /> ITEM <br />COMMERCIAL FIXTURE, NE~ CONST. <br />PLUMBING BASE FEE <br />FLEET SURCHARGE -ZONE 6 <br />PLUMBING STATE SURCHARGE <br /> <br />PAYEE: ISSERG R V PARK <br />RECEIVED BY; cl <br /> <br /> * THIS IS NOT A PEI~4IT. THIS:, <br />FOLLC~ING I~IUST BE CO~IPLETED.,', <br />ALL NECESSARY INFORf~t~TION HAS <br /> <br />q'OTAL:A.SSE~,SED .FEES <br />~REV'IdJS RECEIPTS <br />THIS RECEIPT <br /> <br />BALANCE'DUE <br /> <br /> ,RECEIPT NO: <br />TYPE':'CK' CHECK <br /> <br />QUANTITY AMOUNT <br /> 6 $64.00 <br /> $20.00 <br /> $7.58 <br /> <br /> $85+38 <br /> $0.00 <br /> $85.38 <br /> <br /> $o_oo <br /> <br /> 235?5 <br /> 2151 <br /> <br /> PROCEEDS ri~HERE THE <br /> TO ~RE THAT <br /> <br />PLAN REVIEW: BY DATE <br /> <br />RE./'4ARKS; 8 MASHERS, 2 FLR DRAIN , 1 TUB <br /> <br />CITY JURISDICTION: BY DATE <br /> <br />FORM # MC I5-56 REV 11/88 OFPICE COPY <br /> <br /> <br />