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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 $88-5147 <br />CODE-A-PHONE 4::30 PM.. - 8::00 AM <br /> <br />of a registered builder, <br /> <br />SIGNATURE OF APPLICANT <br /> DATE <br /> <br />DATE; 11./28/89 TIME: 10;42:45 <br /> E~RAN , TOM 90040-$20 <br /> <br /> 855 8TH CONTRAS¥OI¥¥ UG~ <br />AUN~VILLE OR 97325 <br /> AUI~SVILLE NO <br /> <br />SUBDIVISION <br /> <br /> PO BOX 188 <br /> SUBLIMITY OR 97385 <br /> PHONE: 769-?384 SITE NUMBER: <br /> VALUATION: <br />LO~ BLOCK SECTION TOWNSHIP RANGE <br /> <br /> 19 5 25 8S 2W <br />WIDTH ~EPTH AREA UNITS IRREG LOT <br /> 75 100 7500. SF NO <br /> <br />RESIDENTIAL <br /> <br />O00U PANT LOAD <br /> <br />NO OP BEDROOMS <br /> <br /> 8926 <br /> <br /> ZONE MAp <br /> <br /> 51 <br />CORNER <br /> NO <br /> <br />TYPE: MECHANICAL PEF~IlT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. 55493 <br />TOM DORAN <br />PO 80× 185 <br />SUBLIMITY 97385 <br />PHONE: 769-7364 <br /> <br /> ITEN <br />DONESTIO RANGE HOOD <br />DO~ ED~IST FANS & DRYER VENTS <br />MECHANICAL BASE FEE <br />FLEET SURCHARGE -ZONE 3 <br />MECHANICAL STATE ,?AJRCHARGE <br /> <br />9020465 <br /> <br />QUANTITY ,~4OUNT <br />1 $4.50 <br />3 $9.00 <br /> $10.00 <br /> $3.84 <br /> $1.18 <br /> <br />TOTAL A,,gS~ED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$28.52 <br /> $0.00 <br />$28.52 <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE: TO~ DORAN ~ INVOICE NO: 21718 <br />RECEIVED DY: PB ....... ~-~'~=~ , TYPE: IN CHECK ~: 0 <br /> <br /> * THIS IS NOT A PERMIT. THIS APPLICATI(I,I 14UST ~) 'THROU(~9 A REVlEN PROCES~ ~HERE THE <br />FOLLONIN8 ~JST BE C(~PLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASECJRE THAT <br />ALL NECESC~ARY INFOi~4ATION HA,.S BEEN PROVIDED+ <br /> <br />PLAN REVIF'N: 8Y <br />REMARKS: HD FN <br /> <br />DATE <br /> <br />CITY JURISDICTION: BY ..... DATE <br /> <br />F'OR~" MC Th ':1: HF:v ~'87 OFFICE COPY <br /> <br /> <br />