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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 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />Other <br /> <br />I I~ave read and agree to the terms stated on the reverse side <br />this document. <br /> <br />SIGNATUR~ OF APPLICANT: <br /> DATE: <br /> <br />OWNERDA'J'E: 03/13/'91 <br />S~TUS AODr~ESS: JC~rlNE4DN, JiM <br /> <br />TAX LOT; i CATEGORY: <br /> <br /> DAY 682-2420 <br />PHONE: 6'18.-5133 SiTE NUIVlBER: 530 <br /> <br /> EFU <br /> ' <br /> <br />6 <br /> <br />TYPE: PLUFIBiNG <br /> <br />PER,liT OR APPLICATiON NO: 30627 <br /> <br />~'r ~'f'OR, NO. <br />JOHNSON, Jil~l <br />SANE <br /> DAY 682.-2420 <br />PHCNE: 6'/8-5133 <br /> <br />11'Ef'I <br /> Hf.~E SE~NER AND WATER CONNECTION <br /> STATE SU RCHAC'~E <br /> <br />(~d/~l'll'Y AI'4OUN'I' <br /> 1 $25.00 <br /> <br />TOTAL AE~ED FEES <br />PREWIOU8 RECEiPI'3 <br />THIS RECEIPT <br /> <br />$26.25 <br />$26.25 <br /> $0.00 <br /> <br />BALANCE OUE $0.00 <br /> <br />PAYEE: RECEIPT NO: 0 <br />RECEIVED ~Y: CL TYPE~ C~ECK =~ O <br /> <br /> THIS iS A VALID PEI~'4IT ~ THIS PEI~[T EXPIRES 180 DA'Y~ FRONI IT3 1,5..'~£ DATE. iF <br />CONSTRUCTION C~ F'ORA PERIODOF 180 DAYS, OR iF CONSTRUCTION FAILS TO MEET ALL <br />51HREq~LIR~I~E~T$OFSTATE ~ANDIflARION (;OUNTY~I.JILDiN~AND ZCNING ORDINANCES, THIS P£1;~IIT <br /> L B1BOBf4E NULL AND VOID. <br /> <br />RE~,~,RK3: COf~N R~5230 <br /> <br />orONALO E. ~OODLE¥, I~IARION COUNTY BUILDING OFFiCiAL / BY <br /> <br />FORM # MC 15-56 R~V, 4/80 OFFICE COPY <br /> <br /> <br />