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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br />The work will be performed by a registered builder. <br />Other <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 P.M. - 8:00 A.M. <br /> <br /> SIGNATURE OF APPi=ICANT;'~~ <br /> <br />OWNSR: ~TR~, ~ J' TAX LOT'. ! CATEGORY: <br /> <br />SITUS ADDRESS: CONSTRUCTION TYPE: OCCUPANCY: <br />55~? DUMORE DR SE <br />AUNSV~LDE OR 97325 <br /> C~NTRACT CiTY;MC i U~S: OCCUPANT LOAG: <br /> <br />PHONE: 364-6731 <br /> <br />VALUATION: <br /> <br /> ITEM <br />DOM EXHST FANS & DRYER VENTS <br />~_L~{ANICAL BASE FEE <br />Fr,~-r SURCF, ARGE -ZONE 3 <br />MECHANICAL STATE SURCHARGE <br /> <br />PAYEE: SANDSTRUM, EDGAR <br />RECEIVED BY: CL <br /> <br />* TNIS IS NOTA P~. T~IS <br />FOLLOWING I~JST B~ OC~a~ETED. <br />ALL ~ I/I~I~TI(IN HAS <br /> <br />PLAN REVIEW: <br /> <br />IT IS <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br />BALANCE DUE <br /> <br />QUANTITY AMOUNT <br /> 3 $9.00 <br /> $10,00 <br /> $3.84 <br /> $0.76 <br /> <br />$23,60 <br /> $0.00 <br />923.60 <br /> <br />$0.00 <br /> <br />INVOICE NO: 2116 <br />TYPE: CE C'f-~C~#: 1077 <br /> <br /> A REVI~ PROCESS ~t~E THE <br />OF T~E APPLIC~A~T TO ASSURE T~,AT <br /> <br />// <br /> <br />L OFFICE COPY <br /> <br /> <br />