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MARION COUNTY BUILDING INSPECTION <br /> SENATOR SLDG. NO, 225 <br /> 22e,'HIGH STreET NE <br /> ~ SALEM, OBEG~N 97301 <br /> <br /> PHONE 588-6147 <br /> CODE-A-PHONE 4:30 P.M. - 8:00 A.M. <br /> <br />I am performing work on a property I own or occupy. <br />[ afl~ a registered builder OR the authorized representative <br />of a registered builder, <br />The work will be per[ormed by a registered builder, <br />Other. <br /> <br />OWN~: NCRAE, M~'LTON <br /> <br />CATEGORY RESt' DENT IAL <br /> <br /> 939 VENTURA Dr <br />KEIZER <br /> <br />OR 97303 <br /> <br />Nw <br /> <br />CITY. <br /> <br />u?jb <br /> <br />OCCUPANCY <br /> <br />OCCUPANT LOAD: <br /> <br />USE OF BUILDING; <br /> <br />MAILING ADCRESS: <br /> <br />SUBDIVISION: PAU'4A CIEA VILLA It2 <br /> <br />PHONE: 393-0?97 <br /> <br />:SITE NUMBER= <br /> VALUATION <br /> <br />9059 <br /> <br />LOT 8 BLOCK"i 5 ' ' SECTION TOWNSH ~P <br /> <br />RANGE ZONE: MAP: <br /> <br />~g L0'~;NO <br /> <br />CONTRACTOR, NO. 531 <br />MONTAG OF SALEM <br />101 UNION ST NE <br />SALE. h1, OREGON 97301 <br />PHONE: 585-6396 <br /> <br /> ITEM <br />GAS CONNECTION <br />FORC AIR FUF~ 100000 BTU OR LE~S <br />MECHANICAL BASE FEE <br />FLEET ,SURCHARGE -ZONE 2 <br />MECHANICAL STATE SURCHARGE <br /> <br />(~)UANTITY AMOUNT <br />1 $2.00 <br />t $6.OO <br /> $10.00 <br /> ~2.56 <br /> 0.90 <br /> <br />TOTALASS~EDFEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$21.46 <br /> $0.00 <br />$21.46 <br /> <br />BALANCE DUE $0.00 <br /> <br />RECEIPT NO: 22155 <br />TYPE~ CK CHECK ~; 11 <br /> <br />PAYEE.+ fvIONTAG OF SALEN <br />RECEIVED BY: Df4 <br /> <br />~ THI~ IS A Vc,A~LID pEi~IIT * THIS PERMIT EXPIRES 180 DAYS:FRoM :iTS ISSUE DATE IF <br />~f~L~TION..... EASE~ FOR A PERIOD OF 180 DAYS, OR IF CONSTR(JCTION FAIL~ TO f, lE["i' ALL <br />RS~UIRSwlENT$ OF STATE ~ AND MARION COUNTY BUILDING AND ZONING ORDINANCES, THIS PERNIT <br />SHALL BECOME NULL AND VOID. <br /> <br />RET4ARKS: GL/FURN R~2542 <br /> <br />DONALD E. NOODLEY, rClARION COUNTY BUILDING OFFICIAL / BY <br /> <br />FORM ~¢ MD l rS ht~ REV e/e7 OFFICE COPY <br /> <br /> <br />