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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 F~M. - 8:00 A.M. <br /> <br />I am performing work on a roperty i own or Occupy, <br />I am a registered builder On ( ) the authorized representative <br />of a registered builder. <br />The work will be performed by a registered builder. <br />Other <br /> <br />DATE: 09/]!/89 TIME: <br /> OORAN, TOM <br /> <br />SIGNATURE QF APPLICANT: __ <br /> DATE: <br /> <br />TAX LOT; <br /> 96681-801 <br /> <br />CONSTRUCTION TYPE~ <br /> <br />CATEGORY. <br /> FqE,:~_~c~ .. <br /> <br />OCCUPANCY: <br /> <br /> 910 10TH ~... <br />AUMSV! LLE OR 97325 <br /> <br />CONTRACT CITY: dSS: <br />AUMSV I LLE NO <br /> <br />OCCUPANT LOAD: <br /> <br />MAILING ADDRESS: <br /> <br />PO BOX 185 <br />SUBLIMi'TY OR 97385 <br />PH')NB: 789.,-7364 <br /> <br />LOT: BLOCK: SECTION: <br />1 <br /> <br /> 108 <br /> <br /> TOWNSHIP; <br /> <br />25 <br /> UNITS: <br /> <br />SUBDIVISION~ <br /> <br /> G:LOOW ~2 <br /> <br /> SITE NUMBER; 8338 <br /> VALU$TION: <br /> RANGE: ZONE: <br /> <br />88 2W RS <br /> LRREG. ~T: CORNBR: <br />S? YES NO <br /> <br />MAP: <br /> <br />TYPE: PL. UMSiNG <br /> <br />P~RM!T OR APPLICATION NOt <br /> <br />ONTRACIOR, NO. 28638 <br />T.G.NiCHOL __UM,_.NG, )'NC <br />P.O-8OX "86 <br />AUMSVI LLE OR 97325 <br />PI--ONE.. 749-2071 <br /> <br /> ITEM <br />RESIDENTIAL FIXTURE, N~I,4 C0NST, <br />PLUMBING BASE FEE <br />~'L. EET SURCHARGE -ZONE 4. <br />c>]_UMBING STATE SURCHARGE <br /> <br />9018778 <br /> <br />TOTAL AS~ESSEB~,FEES <br />PREVIOUS RECEYPTS <br />THIS RECEIPT <br /> <br />$82.82 <br /> $0,30 <br />$82. % <br /> <br />BALANCE DUE ,>" .... 6, ~ ,,'~ <br /> <br />P.A,.~EE: TOIV DORAN CONS'" ~(~ INVOICE NO '9906 <br />RmQ['~ZVED EY. PS ~ T?~E2:,~'N C~ECK ~ O <br /> <br />* ~IS IS NOT A FE~ZT. ~ZS; AP~'~CAT2~,, ~ST ~ T~',A R~Z~ P~E~ ~ERE THE <br />FOLL~ING ~ST BE ~PLETED. t:,~T,.,,;IS ~E', ,R~S~B:Ib,I~ ,OF ~E APPLICANT TO A~RE THAT <br />ALL NEC~ARY INFO~TI~ H~,,';BE~,P~V,IDED_" ' : <br /> <br />rq.,A~q ~EViE~.: Bv ................ OA~ .... ,,",:' C{TY JURISDICTION: DY ........ O/,'rE ......... <br />REMARKS: 6 FIX <br /> <br />FORM ¢ MC 16,~6 R~V, ~1/68 OFF[CE COPY <br /> <br /> <br />