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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-$147 8,00 - 4::30 <br />24 HOUR CODE-A-PHONE:: 588-7904 <br /> <br />Other <br /> <br />SIGNATURE OF APPLICANT <br /> DATE <br /> <br />,:}w~¥ E: 12/05/90 <br /> <br /> DORAN, [OM <br />SITUS ADDRESS <br /> <br />TAX LOT <br /> <br />90040-470 <br /> <br /> 89O 8'tH '~f <br /> AUIv~Vi LLE <br />US£ OF BUILDING <br /> <br />OR 97325 <br /> <br /> CONTRACT CITY <br /> <br />AU~,SV I LLE <br /> <br />UG8 <br /> <br />NO <br /> <br />MAiLiNG ADDRESS <br /> <br /> BOX 185 <br />~BL, IMIIY OR 97385 <br />PHU'NE: 769-7364 <br /> <br />t4 95 ?030. 5F NO NO <br /> <br />C~,TEGORY <br /> <br />OCCUPANT tOAD <br /> <br />NO OF BEDR00Mb <br /> <br />lYRe: MECHANICAL PERNIf OR APRLICA¥iON NO: <br /> <br />CON IRACiOR, NO. 55493 <br />FOM DORAN <br />PO BOX 185 <br />~UBLIMifY 97385 <br />PHON~: 769-~364 <br /> <br />BOMESFIC P-~NG~ ROOD <br />DOM EXHSI FANS & DRYER VENI5 <br />MECHANICAL BA.SE FEE <br />FL.EE'I ,%:gJRfJHARGE -ZONE <br />NECHANJCAL b~Ai~ SDF~HARGE <br /> <br />PAYEE: TO~ OORAN <br /> <br />g029111 <br /> <br />fOTAL A~E~ED FEES <br />PR~WIOUS R~CE~pII~ <br /> <br />QUANfIiY AF'tOUNI <br />I $4.50 <br />3 $9.00 <br /> $~o.o~ <br /> $3.84 <br /> $~.~8 <br /> <br />$28_52 <br /> $0.oo <br />$28.52 <br /> <br />BALANCE CUE $0-O0 <br /> <br />INVOICE NO: 30763 <br /> <br /> RECEIVE0 BY: Pb IYP~: IN CHECK ~t 0 <br /> <br />* THiS IS NOT A PERDI~T. THIS APPL~C~IIIC~ /MUST GO THROU~t A RE¥~ PP~)C~ [qHERE THE <br />FOLLO~/ING D!lJS"I' 8E C~PLETEO. iT IS THE R~PONSIBiLITY OF THE APPLICjAN~ TO A~E~JRE THAT <br />ALL NEC~F~F iNFORMATION R~ BEEN PROViOED. <br /> <br />PLAN REVIEW: 8Y <br />REMARF~: MD FN <br /> <br />DATE_ ................ CITY JURiSDiCf'IC~: 8Y DArE <br /> <br />FORM # MC 18-~6 RBV 4/~1 OFFICE COPY <br /> <br /> <br />