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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 <br /> CODE-A-PHONE 4:30 P.M. - 8;00 A.M. <br /> <br />I am performh/g work on a property I own or occupy. <br />I am a registered builder OR the authorized represen ave <br />of a reg)stered builder, <br />The work will be perforf~ed by a registered builder. <br />Other <br />I have read 8nd agree to ~he terms stated on the reverse side <br /> <br />DATE: 10/27/88 "r I~E ~ , 4.:.~.4 ;4op <br /> COAKLEY, RODNEY & NARTA <br /> <br />SIGNATURE <br /> <br /> ; CAT, GORY; <br />58055-000 RESIDENTIAL. <br /> <br />iSITUS ADDRESS; I CONSTRUCTION TYPE: ! OCCUPANCY: <br /> <br />' 5785 SHA~ HWY <br /> I CONTRACT CITY: i U88; iOCCUPANT LOAO: <br />,i AUfz~BVILLE OR 97325 <br /> RZ~ ~N~ i NO <br />iUSE OF BUiL~ING: N0 OF BEDROOMR: <br /> <br />i f~AtI,,I N ~ ADORE~: SUBDIVISION: <br /> <br />PHONE: 581-1872 SITE NUNIBER: 3195 <br /> VALUAT I ON: <br /> <br /> , 4. 90000 i AC ' NO NO <br /> <br />TYPE: PLUN8 ING <br /> <br />PERNIT OR APPLICATION NO: 9012204 <br /> <br />CONTRACTOR, NO. <br />COAKLEY, RODNEY & IvlAR~'A <br /> <br />PHONE: 581-t872 <br /> <br /> ITEN <br />NOSILE HONE SEWER AND HATER CONNECTION <br />FLEET SURCHARGE -ZONE 3 <br />PLUNSING STATE SURCHARGE <br /> <br />,,TOTAL ~I=~ED FEES <br />: PREV:TCtJ$ RF-.CEI' PTS <br /> , <br /> <br /> E <br /> <br />PAYEE: COAKLEY, RODNEY & <br /> <br />* THiS IS NOT A PEI~iIT. <br />FOLLOWING t4UST 8E CONPLETED.: IT <br />ALL NECESSARY INFOI~'~ATlrON 'HAS BEEN <br /> <br />PLAN REVIEW: BY BATE' <br />RENARKS: 1~4 CON R'~5645 <br /> <br />q~ANT I TY <br /> 1 <br /> <br />AMOUNT <br /> $25.00 <br /> $3.84 <br /> $1.25 <br /> <br /> $0.00 <br /> $30.09 <br /> <br /> $0.00 <br /> <br /> BECEIPT NO: 12957 <br /> iT~PE.~.~;CK,. CHECK ~: 3348 <br /> <br /> PROCESS N'tERE THE <br /> TO ~RE ~AT <br /> <br />URISDICTI~: 8Y ........ DATE <br /> " <br /> <br />,ORM ,* ~p ~,se R~V ~/.r OFFICE COPY <br /> <br /> <br />