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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. N'O, 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 />i am performin¢l work on a property I own or occupy. <br />I am a registered builder OR ( ) the authorized representative SIGNATURE 0¢ APPLICANT; <br />of ~ registered builder, <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 DATEI <br /> <br /> KNOX, MICHAEL G & LiNOA L <br />SI1US ADOSESS: <br /> <br />'tAX LOT; <br /> <br />CONsTR(JCflON TYPE: <br /> <br />CATEGORY: <br /> <br />OCCUPANCY: <br /> <br /> 6691 PE'rERr5 Rr,~D SE 'dG~F~AE'r~m~} !U~e <br />AUI~,]VI L. LE OR 9?325 <br /> I',IAR.1;ON CCf,,JN'f'Y : NO <br />USE OF ~UILDING: <br /> <br />10965 JAI'4ES WAY <br />AUf~1'SV [ LLE 97825 <br />PHONE.* 749-2155 <br /> <br />~E <br /> <br />?. AC <br /> <br />S ,I, 'l' E NUMt9 ER.* 9586 <br />VALUAI' I ON: <br /> <br /> ~ H AR <br /> YES NO <br /> <br />MAP: <br /> <br />TYPE: PLUIVl81NG <br /> <br />PERIMiI' OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. <br />KNOX, MICHAEL G & LINBAL <br />10985 JAMES NAY DRIVE SE <br />AUI~4~V/LLE 97325 <br />PHONE: '1~9-2155 <br /> <br /> ~'i'E~ <br />I, NATER LiNE~, I~T 10O FEET <br />NATER LINES. EA. ADOL. 100 PEET <br />MOEIILE HOC4E SE~ER AND !A~A'i'ER C. gNNEC't'ION <br />PLU~iNG ~E FEE <br /> <br />PLU~[NG STATE ~A~E <br /> <br />9029125 <br /> <br />TOTAL A"SS~EO FEES <br />PRE~iOUSRECEiP'TS <br />THIS RECEIPT <br /> <br />QUAN'rl'fY A!vlOUN'I <br /> <br /> 2 $30+00 <br /> $25.00 <br /> $20+00 <br /> ~3.84 <br /> 4.75 <br /> <br />$103.59 <br /> $o.oo <br />$103~59 <br /> <br /> ~tI%/ANCE DUE <br /> PAYEE: <br /> KNOX, <br /> RECEiVED <br /> BY: <br /> ,__~ 7'-----> TYPE: OK C~£CK ~: 2901 <br /> NtCHAEL G ~ LiNDA L '~% ,RECEIP'[ NO: 3~783 <br /> <br />· TH~$ ZS NOT A PEI;~lJT. TH~$ APPLJ~T~ ~ST ~ TH~ A R~Z~ P~ ~ERE THE <br />FOL~ZNG ~T BE ~PLETED, ~ ~S TH~ R~SJBZLZTY OF THE APPL~'r TO ~RE THAT <br />ALL N~ ZNFO~T~ H~ BE~ P~VZDED. <br /> <br />PLAN REViEN: BY DATE <br /> <br />REi~tARF.,~: CONN/300' WL R:l~t4728 <br /> <br />CiTY JURISDICTION: 8Y DATE <br /> <br /> OFFICE COPY <br />PeRM # MC ~5-56 REV, <br /> <br /> <br />