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MARION COUNTY BUIpDING INSPECTION <br />SENATOR BLDG, NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />Other <br /> <br />SIGNATURE OF APPLICANT; <br /> <br />08/27/90 <br /> <br />URY, DAVE <br /> <br />11':29*+87 i TAX LOT: <br /> CONStRUCTiON <br /> <br />RF~IDENI'IAL <br /> <br /> 5983 NALINA COURT <br />AUI~VILLE OR 97325 <br /> <br />~E ~TRACTC~TY: UGS; <br /> ~IARjON COlJNTY NO <br /> <br />ROLLING 6REEN ESTATES ~NES'I' <br /> <br /> PHONEs SiTE NUMBER: 10585 <br /> YALUAT tON .' <br />LOT: ~l,,OC K: : ~CTION; : ~O~)~HiP RANG~: ZON~ MAP: <br /> <br /> 1~ DEPTH: I 'AREA: ~ ~O~fS; 8~: I~E~. LOf: ~ GSR~E~; AR <br /> 156 41~ . SP' Y~ ] NO <br /> <br />TYPE: PLUIlq~ ING <br /> <br />PERMIT OR APPLiCATiON NO: 9026?50 <br /> <br />CIANI'R~gl'OR, NO. 52354 <br />F~g~DY FULTZ (YDNSTRUCTION <br />1004'I 5TAY'I'ON RD BE <br />AUP~i~ViLLE, OR <br />PHONE: ?59-5385 <br /> <br /> l'fF.~ ~)AN'fiTY <br />WATER LiN~, 1S'f' 100 FEET 1 <br />SEWER LiNE~, 1S'1' t00 FEET 1 <br />FLEET ~URCHARGE -ZONE 3 <br />PLUMB~N~ ~'FATE SURCHARGE <br /> <br />TOTAL A,~5~ED <br />PREVI(:XJS RECEIPTS <br />:::'tH ~S :RECEIPT <br /> <br />20.00 <br /> <br />$3.84 <br />$2.50 <br /> <br />$56.34 <br /> $o.oo <br />$56,34 <br /> <br />BALANCE BUE $0.00 <br /> <br />PAYEE: RANDY PJL'FZ CONSTRUCT,ION <br />RECEIVED BY: c'l <br /> <br />RECEIPT NO: 28309 <br />TYPE: OK C~ECK ~: 1695 <br /> <br />~ ]ltl$ I~ NOT A PER~IT. TH:iS APPLiCATII~I f~L~T ~ ~ A ~1~ ~ ~ THE <br />~1~ ~T BE ~.~ ~lBI~l~ ~ ~E ~I~T TO ~ THAT <br />A~ N~ IN~TI~ ~B~ ~I~. <br /> <br />PLAN REViEN; BY .................................... <br /> <br />RE~RKS: ~L SL R~3994 <br /> <br />CiTY JURiSDiCTiON: BY [1ATE <br /> <br /> FORM # MC 1 $,~6 REV, 4¢0 <br />L <br /> <br />~FFICE~COPY <br /> <br /> <br />