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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 A M, <br /> <br /> I have read and agree to the term,; stated on the revers~ sid~ of- .... <br /> <br />DATE: 09/27/89 TIME: 8~48: 12a <br /> <br /> TOM ~ ~ST~OTI~ <br /> <br />SIGNATURE OF APPLIOAN f <br /> <br /> DATE <br /> <br />TAX LOT <br /> <br />CONSTRUCTION TYPE <br /> <br />90061-311 <br /> <br />RESIDENTIAL <br /> <br /> 995 HAZEL ST <br />AUMSVI LLE OR 97325 <br /> <br />CONTRACT CITY UGB <br />AU~VILLE NO <br /> <br />NO O~ 8EDHOOMS <br /> <br />PO BOX 185 <br />SUBLIMITY OR 97385 <br />PHONE: 769-7364 <br /> <br />LOT BLOCK SECTION TOWNSHIP <br /> 5 4 25 85 <br /> 64 80 SF <br /> <br />SUBDIVISION <br /> GI LDO~ ~2 <br /> <br /> SITE NUICSER: 8457 <br /> VALUAT ION: <br />RANGE ZONE <br /> 81~I RS <br />IRREG LOT CORNER <br /> YES YES <br /> <br />MAP <br /> <br /> 51 <br /> <br />TYPE: MECHANICAL PERNIT OR APPLICATION NO: 9019189 <br /> <br />CONTRACTOR, NO. 55492 <br />TOM DORAN <br />PO BOX 195 <br />SUBLIMITY 97385 <br />PHONE: 769-7364 <br /> <br /> ITEN <br />DONESTIC RANGE HCOD <br />DON EXHST FANS & DRYER VENTS <br />MECHANICAL BASE FEE <br />FLEET SURCHARGE -ZONE 3 <br />NECHANfCAL STATE SURCHARGE <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY <br />1 $4.50 <br />4 $12.00 <br /> $10.00 <br /> ~3.84 <br /> 1.33 <br /> <br />$31,67 <br /> $0.oo <br />$81.$7 <br /> <br />SAL.~NCE DUE $0.00 <br /> <br />PAYEEs TOM DOEAN ,¢¢x¢ INVOICE NO: 20858 <br />RECEIVED BY- I:~ TYPE~ IN CHECK ~: 0 <br /> <br />* THIS IS NOT A PEI~IT. THiS APPLiCATION MU~T ~O THROU~H A REVIEN PROCESS I~I-IERE THE <br />FOLLOWIN~ NUST BE J33~PLETEI). IT I$ THE RE.:~IBILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFOI~IATION HAS 8~ PROVIDED. <br /> <br />PLAN REVIb-~: BY ....... DATE <br />RE'lARKS: HD FN <br /> <br />CITY JURISDICTION= BY ........ BATE <br /> <br />F¢INM ¢ M(; ~5.56 RE',, JJ'RB OFFICE COPY <br /> <br /> <br />