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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 PM - 8::00 AM <br /> <br /> Iarn performfng work on a property I own or occupy <br /> I am 8 rogistorod builder OR the authorized representative <br /> of a regmtered budder <br /> Tho work wdl be performed by a regmtered builder <br /> Other <br /> I havo road ~nd agree to the terms stated on the reverSO s~do Of <br /> <br />DATE: 01/19/89 TINE= 2:56:11p <br /> <br /> LOUI',IENA , DANIEL <br /> <br />700 <br /> <br />RES1 DENT1AL <br /> <br /> 10526 1'4ATTHIEU LANE NE <br />AURORA OR 97002 <br /> <br /> CONTRACT CITY UGB <br />MARION COUNTY NO <br /> <br />MAILING ADDRESS <br /> <br />SAME <br /> <br />PHONE*. <br /> <br />LOT <br /> <br />WIDfH <br /> <br />678-538? <br /> <br /> BLOCK SEOTION TOWNSI <br /> <br /> 08 43 <br /> DFPTH AREA 28 . 8900 UNITS AC <br /> <br />SITE NUNBER: 6341 <br />VALUAT I ON; <br /> <br /> lW EFU <br />I~ LOT NO c°n"~"ON <br /> <br />MAP <br /> <br /> 4 <br /> <br />TYPE: PLUNBING <br /> <br />PERNIT OR APPLICATION NO; <br /> <br />13469 <br /> <br />CONTRACTOR, NO. <br />LOUMENA , DAN I EL <br />SA~E <br /> <br />PHONE: 6'78-5387 <br /> <br /> ITEM <br />WATER LINE. S, 1ST 100 FEET <br />MOBILE HONE SEWER AND WATER CONNECTION <br />FLEET SURCHARge -ZONE 6 <br />PLUMBING STATE SURCHARGE <br /> <br />QUANTI"fY AMOUNT <br />1 $20.00 <br />1 $25.00 <br /> $7.68 <br /> $2.25 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$54.93 <br /> 54.93 <br /> $o,00 <br /> <br />BALANCE DUE $0_00 <br /> <br /> PAYEE: RECEIPT NO: <br /> RECEIVED BY~ DN TYPE: CHECK ~: <br />.................... '"~%~%%~% ....... =_--~%-~%~,~-~ .................................... <br /> ~ ]'HIS IS A VALID PERNIT ~ THIS PER~IT EXPIRES 180 D~Y~ FRO~ ITS ISSUE DATE. IF <br /> CONSTRUCTION CE.A~F-~ FOR A PERIOD OF 180 DAY~, OR IF CONSTRUCTION FAILS TO NEET ALL <br /> REQUIREMENTS OF $TATE LANS AND MARION COUNTY BUILDIN~ AND ZONIN~ ORDINANCES, THIS PERMIT <br /> ,GHALL BECOIflE NULL /~D VOID. <br /> <br />RENARKS: CONN & WATER LINE R~5420 <br /> <br />DONALD E. WOODLEY, MARION COUNTY BUILDING OFFICIAL <br /> <br />FO"M ¢F MC ~5-~6 R[¥ 11'88 OFFICE COPY <br /> <br /> <br />