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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 8:00 - 4:$0 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am performiD9 work on a property I own or occupy. <br />I am a registered builder OR ( ) the 8uthorJzed rep*esentative S~GNATLJRE OF APPLICAN,r: <br />of a registered builder, <br />The work will be performed by a registered builder, <br /> <br />°w~C~l'E; 10/04/90 'I'IME: 10:01:22 <br /> <br />SITUS AOORESt~LARK; COROTHY <br /> <br />RES f r)P..N [i AL <br /> <br /> ?722 TERRANCE LANE <br /> AUI'~Vi LLE <br />USE OF BUILDING: <br /> <br />SE <br /> <br />CONTRACT CITY: ; UGB: <br />MARION Cf.)UN TY <br /> <br />NO <br /> <br />OCCUPANT LOA0: <br /> <br /> SAr,IE <br /> <br /> PHONE.* 749-4312 <br />t,OT: i BLOCK; <br /> <br />SECTION: ' TOWNSHIP: <br />I ~l~A: 26 U NrTS'. <br /> <br />fERRANCE <br /> <br />si'rE NUFCSER: 2043 <br />BAN~'~'LUA'r j~ON; : ZONE: <br /> <br />8S : IRREG. LOT: ~1 ' CORNER: AR <br /> <br />MAP: <br /> <br /> 51 <br /> <br />TYPE; D1ECHAN ICAL <br /> <br />(;;ON '[' RAC'I'OR, NO. <br />CLARK, DOROTHY <br /> <br />PHONE: 749-4312 <br /> <br /> ! TEM <br />DO~E~'f'IC HOOD STOVE <br />r4EOctANICAL BASE FEE <br />FLEET ~3URCHARGE -ZONE 3 <br />MECHANICAL STATE 5~URCHARGE <br /> <br />PAYEE; CLARK, BO,C~OTHY <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />27759 <br /> <br />TOTAL ~F_JD <br />pRF,-'~,' l OUS REC. F.¢ i pT$ <br />'rH~s RECEIPT <br /> <br />0UAN'rITY ~OUN'f <br /> 1 $7.5o <br /> $10.00 <br /> $3.84 <br /> SO.eS <br /> <br />$22.22 <br /> $0.00 <br />$22.22 <br /> <br />BAU~CE Q~E $0.00 <br /> <br />RECEIPT NO~ 29948 <br /> <br /> RECEIVED BY: PB TYPE: CK CHECK ~: 2210 <br />~ THiS iS A VALID PEt~41T * THiS PER~IT EXPIRES 180 ~AY~ FROf~ ITS i,%.~AJE DATE+ IF <br />~S'r~CTI~ C~ FOR A PERIOD OF 180 ~, OR ~ ~ST~CTI~ FAI~ TO ~EET ALL <br />REdiReCTS OF STATE ~ ~0 ~RI~ ~NTY BUILDING ~D Z~1NG ORDIN~C~, THIS PE~iT <br />~ALL B~E NULL <br /> <br />RECCC. RKS: INSTALL NOOO~'f'OVE R'&t2953 <br /> <br /> NOODLE¥, ~ARioN C'C~NTY BUILDING OFFiCiAL / BY ................................... ~ ............................................. <br />DONALD <br /> E. <br /> <br /> OFFICECOPY <br />FORM # MC 15,56 REV, <br /> <br /> <br />