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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OP~EGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 P,M. - 8:00 A.M, <br /> <br />Other <br /> <br />I have read and agree to the terms stated on the reverse side of <br />this document. <br /> <br /> CLARK, ~RTIN <br />SITUS ADDRESS: CONSTRUCTION TYP~: ~ OCCUPANCY: <br /> 20521 B~ PER~ RD N~ '~6~'~;¥9~ .... J~6~i~+ LbA~: <br /> AURO~ OR 9~002 <br /> ................................... ~R-~--~N~¥.-.j ...... <br />0SE OF BUILDING; <br /> <br />MAILING ADDRESS; <br /> <br />P.O, BOX 168 <br />AURORA, oREGON 97002 <br />PHONE: 678-1139 <br /> <br />LOT: ; BLOCK: <br /> <br />WIDTH: :DEPTH: <br /> <br />SITE NUNBER: 3367 <br /> <br />TYPE= MECH,AN[CAL <br /> <br />CONTRACTOR. NO. 335?2 <br />CANSY PLUfC~ING <br />805 NE 4TH <br />CANBY, OREGON 97013 <br />PHONE: 268-2091 <br /> <br />PERNIT OR APPLICATION NO: 6026 <br /> <br /> ITE~ <br />FORC AIR PURN 100000 BTU OR LES.S <br />D_~AS WATER HEATER <br />MECHANICAL BASE FEE <br />FLEET SURCHARGE -ZONE 5 <br />MECHANICAL STATE SURCHARGE <br /> <br /> , ::, ,, ,;'PREV!(3JS 'RECEIPTS <br />' ' ':: :'IHIS REOE~ <br /> <br />(~JANTITY <br /> 1 <br /> 1 <br /> <br />ANOUNT <br /> <br /> $10.00 <br /> $6.40 <br /> $1.18 <br /> <br />$31.08 <br /> $0.00 <br />$31.08 <br /> <br />$0+00 <br /> <br />PAYEE: CANBY. PLUIV~BING : .... ] RF_X~'EIPT NO.* 6607 <br />RECEIVED BY. CL __. : .: ,~q~YPEz::,CK,,,i:CHECK ~: 9486 <br />* THZ8 ZS A VALZD PERMIT * THIS PE~4[T <br />~[R~ OF ~ATE <br /> <br />~ALD E. ~DLEY, NAR[~ COUN~ 8UZLD~N~ ~FF[CiAE,/ <br /> <br />FORM" MC 1~-56 REV e/~7 OFFICE COPY <br /> <br /> <br />