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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br />I Bm a registered builder OR ( ) the Authorized representative <br />of a registered builder, <br /> <br />Other,,, <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 P.M. - 8:00 A.M, <br /> <br /> R <br />TAX LOT; ', CATSOORY: <br /> <br /> 557'2 DUF~RE :1~ <br />AD~55;I~ OR 97325 <br /> <br />USE OF BUILDING; <br /> <br />CONSTRUCTION TYPE'. <br />CONTRACT CITY:~j~ <br /> <br />' (JOB: ! OCCUPANT LOAD: <br /> <br />364-6731 <br /> <br />SUBDIVISION: <br /> <br /> SITE ~: i107 <br /> VALUAT I ON: <br /> <br />LOT: BLOCK; <br />WIDTH: DEPTH: <br /> <br />CON'i"RACi~R, hO. <br /> <br />SECTION: TOWNSHIP: <br />AREA UNITS <br /> <br /> IT]i~ <br />P, ESID~NTIA~ FIXTURE, ALTF~ATIONS <br />PLUMBING BASE FEE <br />FLEET SURCHARGE -ZONE 3 <br />PLU~ING STATE SURCHARGE <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS REOEIPTS <br />THIS RECEIPT <br /> <br />BALANCE DOE <br /> <br /> PAYEE: SANDST}~IiM, EDGAR J. /.~_ ./¢.-~. // <br />.... .... . ...... <br /> * T~IS IS NOT A PERMIT. <br /> FOLLOWIN~ ~ ~ ~. IT <br /> <br />PLAN REVIEW: BY <br /> <br /> QUANTITY A~OUNT <br /> 2 $15.00 <br /> $10. O0 <br /> ~3.84 <br /> 1. OO <br /> <br /> $29.84 <br /> $O. O0 <br /> $29.84 <br /> <br /> 8o. O0 <br /> <br />INVOICE NO: 21J. 8 <br />TYP~: OK CHEOK #: 1077 <br /> <br /> (~ TH~ APPLICANT TO A~SU~ THAT <br /> <br />BY DATE <br /> <br />OFFICE COPY <br /> <br /> <br />