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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 430 PM - 800 AiM <br /> <br />I am performing work on a property ~ own or occupy <br />I am 8 registered builder OR I ho au ho zed eD esen ave <br />of a registered buPder <br />The work will be performed by a registered builder <br />Otho¢ <br />I have read and agree to the terms stated on the reverse side of <br />this document <br /> <br />SIGNATURE OF APPLICANT <br /> <br />OWNER. <br /> DATE: 05/10/89 TINIE: 10:55:33a <br /> <br />SITUS AoonEs~DORAN, TOM <br /> <br />TAX LOT <br /> <br />0ONSTRUCTiON TYPE <br /> <br />90040-290 <br /> <br />CATEGORY <br /> <br />OGGdPANGY <br /> <br />RESIDENTIAL <br /> <br /> 815 8TH ST <br />usabLE OR 97325 <br /> <br />MAILING ADDRESS <br /> <br /> CONTRACT CITY <br /> <br />AUr~VILLE <br /> <br />NO <br /> <br />NO O¢SEOHOOMS <br /> <br /> P.O_ BOX 185 <br /> SUBLIMITY, OR 97385 <br />co,rPHONE: <br /> <br /> 25 8S <br />75,, 827..90 ~? <br /> <br />7208 <br /> <br />RS <br /> <br />NO .... NO <br /> <br />M&P <br /> <br /> 51 <br /> <br />TYPE.- PLUMBING <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO- 55492 <br />TOM [30RAN <br />PO 80X 185 <br />SUBLIMITY 97385 <br />~HONE: 769-7354 <br /> <br />ITEM <br />RESIDENTIAL FIXTURE, N~ CONST, <br />NATER LINES, 1ST 100 FEET <br />SEWER LINES, 1ST 100 FEET <br />PLUMBING BASE FEE <br />FLEET SURCHARGE -ZONE 3 <br />PLUMBING STATE SURCHARGE <br /> <br />PAYEE: TOM DORAN <br />RECEIVED BY: ¢1 <br /> <br />9015810 <br /> <br />QUANTITY AMOUNT <br />8 $54.00 <br />1 $20.00 <br />1 $30.00 <br /> $20.00 <br />\ $3.84 <br /> $8.20 <br /> <br />TOTAL ASS. F.S~ED FEES <br />PREVIOLIS RECEIPTS <br />THIS RECEIPT <br /> <br />$134.04 <br /> $0.00 <br />$134.04 <br /> <br />BALANCE DUE $o+ 00 <br /> <br />INVOICE NO: t6799 <br />TYPE: IN CHECK ,~: 0 <br /> <br />* THIS IS NOT A PF,,B4IT. THIS .APPLICATION MUST 60 THI~(~'..t A REVIB PJ~0CE$f, [,~IERE "il-tE <br />FOLL(~ING I~,II.I~T BE COfflPLETED. 'fT ,IS THE RE~IBILITY OF THE APPLICANT TO A.,%.SURE THAT <br />ALL NEC~RY INFOR~4ATION HA~ BEEN PROVIDED. <br /> <br />PLAN RE'VIEN: BY .......... DATE <br />RFJ'4ARKS: 6 FIX, NL ,SL <br /> <br />CITY JURISDICTIONs BY <br /> <br />BATE <br /> <br />~O~U ~ MO ~S-~ n~v I1'.~ OFFICE COPY <br /> <br /> <br />