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MARION COUNTY BUILDING INSPECTION <br />SENATOR ELD,G/NO, 225 <br />220 HIGH, STREET NE <br /> SALEM, O~EGON 97301 <br /> <br /> PHONE:: 588-~;1 ~' 8~00 - 4;30 <br /> 24 HOUR CODE~A-PHONE:: 588-7904 <br /> <br />Other__, , <br /> <br />SIGNATURE OF APPLIOANT <br /> DATE <br /> <br />ow~E: '~1/19/9o <br /> r~OOOE, HENRY <br />SITUS ADDRESS <br /> <br />: TAX LOT <br /> OONCTRUCTION TYPE <br /> <br />OCCUFANCY <br /> <br />RESi DEN f JAL, <br /> <br /> 20531 NA~f'HIEU S¥ <br />AURORA <br /> <br />OR <br /> <br />MARION Cf,,2JN f'Y ' NO <br /> <br />PO BOX 362 <br />L,'ONALD 91020 <br />PHONE: <br /> <br />LOT BLOCK SECTION <br /> <br />SiTE NUMBER: 11752 <br />...... ¥,ALUA'f I (.~: ..... <br /> TOWNCHJP RANGE I ZONE <br /> <br />'!. 5 AC .NO NO <br /> <br />MECHANICAL P~-F~II OR APPL. ICAT'ION NO: <br /> <br /> t 1 EM <br />GAS CONNEC f iON <br />I;ORr, J AIR PURN 100000 <br />M~CHANICAL BASE FEE <br />ELEP=I ~E61iA~g -Z-ONE <br />~OHANICAL ~fAfE ~HA~E <br /> <br />9028826 <br /> <br /> QUAN I i fY A~OUN [ <br /> t $2 .rJ0 <br /> 1 $6.00 <br /> $10.00 <br /> <br /> ,, $0_ 9o <br />TO1AL AS.~ES~ED ~EES $26-58 <br />THiS RECEIPT $o.oo <br /> <br /> RECEIVED ~Y: C,~2 ......... ;; ............. ~, ~. .... TYPE.* CHECK ~: 0 <br /> <br />:~ THiS iS NO] A PERMIT. THI~ APPLICATION t~J~T ~O THROUEH A R~i~ PR~ ~ER~ TH~ <br />FOLL~NG ~T B~ ~PLETEO. IT IS THE R~SiBiLiTY OF TH~ APPLi~"r TO ~RE THA'~ <br />ALL N~ INFO~ATI~ <br /> <br />PLAN Rg~/iEW: BY OAFE <br />R~;MARK~: GL/PURN P~4 ~35 <br /> <br />CiTY JURISDICTION+. ~Y .... DAIE <br /> <br />OFFICE COPY <br /> <br /> <br />