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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 />The work will be performed by a registered builder, <br />Other .................... <br /> <br /> DATE; 11/05/87 TIME: 4:13:12p <br /> <br />OWNER: VAN TASSEL, GERALD CAx LOT: <br /> <br />°ATE; /./- - o¢' ? <br /> <br />SITUS ADDRESS: <br /> <br /> 11557 GROUSE LAKE <br /> AURORA <br /> <br />USE OF BUILDIN~I <br /> <br /> SAME <br /> <br /> I CONSTRUCTION TYPE; TO¢¢bPANC¥; <br /> <br />OR 9?002 <br /> MARION COUNTY <br /> <br />SINGLE FAMILY DWELLINGS <br /> <br />PHONE: 578-2362 <br /> <br />LOT; <br /> <br />CENTRUY MEADOWS <br /> <br /> , SITE NURSER: 3038 <br /> i VALUATION: <br /> <br />TS~CTION: i TOWNSHIP: ,RANGE: .... <br /> <br /> AREA: ~; UNITS: I tRR~G. LOT: <br /> NO <br /> <br />TYPE: MECHANICAL <br /> <br />CONTRACTOR, NO. <br />VAN TASSEL, GERALD <br />SAME <br /> <br />PHONE: 678-2352 <br /> <br />PERMIT OR APPLICATION NO; 5422 <br /> <br /> ITEM <br />DOMESTIC WOOD STOVE <br />MECHANICAL BASE FEE <br />FLEET SURCHARGE -ZONE 5 <br />MECHANICAL STATE SURCHARGE <br /> <br />":;:,}OTAL ~E~ED,,FEES <br /> PRBV I,O~S ~ECEIPtS <br />';:, THIS RECEIPT <br /> <br /> :BA~¢E Bt JR <br /> <br />QUANTITY AMOUNT <br /> $7.50 <br /> $t0_00 <br /> ¢7_58 <br /> 0.58 <br /> <br />$26.06 <br /> $o.0o <br />$2~.08 <br /> <br />$0.00 <br /> <br />RECEIVES BY,: JB ............. _~_~ TYPE:: CK,:CHECK ~: 350 <br /> <br />~BCTI~ CBS FOR A P~IOD ::F,~TZ~ FAI~ TO ~ ALL <br />~ B~ NULL ~D ~ID2 ' <br /> <br />REMARk: W.S. R~8134 <br />DONALD ~. NOODL~Y, MARION C~NTY BUILDING oFFiCIAL / BY <br /> <br />.O.M ,, MC ~,-~t¢ .~V ~/~ OFFICE COPY <br /> <br /> <br />