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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 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> I aff~ performing work on a property I own or occupy. <br /> l am a registered builder OR ( )theauthorizedreDresentative <br /> of a registered builder, <br /> The work will be perfornled by a registered builder. <br /> Other <br /> I have read and agree to the terms stated on the reverse side of <br /> this document. <br /> <br /> OAf E: 10/23/91 'f'i~E: 9:23:41 <br />OWNER: <br /> HOOVER, LARRY <br /> <br />SIGNATURE OF APPLICANT: <br /> DATE: <br /> <br />TAX LOT: , CATEGORY: <br /> 90080~020 <br /> <br /> 213 6'tH ST <br />Aur4~ViLLE OR 97325 <br /> <br />CONTRACT CIYY: UGe; OCCUPANT LOAD: <br />AUr4SV [ LLE NO <br /> <br />MAtLtNG ADDRESS; <br /> <br />PO BOX 9?2 <br />AUMSViLL£ OR 9'I325 <br />PHONE: 749-1401 <br /> <br /> 5 <br />WIDTH: iDEI2f~: : AREA: <br /> 10~ 97, <br /> <br /> MERR,[ P',], EL~ AOD1 'f'iON <br /> <br /> ~].TE NUMBER: 10928 <br /> VALUAT ,[ON: <br /> ! ~OWNSHIR: ' RANGE: ZONEi MAP: <br /> 25 8S ~W <br /> ;UNITS: IRREG LOT; ,CORNER: <br />10476, ~F NO YES <br /> <br />TYPE; MECHANICAL PERMIT OR APPLiCA'r'~ON NO: <br /> <br />36280 <br /> <br />CE,~4'I'RACI'OR, NO. 023&"~ <br />, S~a~on Re~rfigera~flon Co <br />20'1 3pd S~ <br />S~a~or~, 9'1383-0000 <br />P140NB: 769-3495 <br /> <br /> z'rE~ <br />G/~ OONNEC'r[ON <br />F'ORC AZR F~RN 100000 BTU OR LEL~ <br />MECHANICAL BASE FEE <br />~EO~AN,[CAL STATE ~SURCHAREE <br /> <br />QUAN'f',['f'Y AtWDUNf <br />1 $2.00 <br />1 $6,00 <br /> $10_00 <br /> $0,90 <br /> <br />TOTAL Ar$S~ED FEES <br />PREVIOUS RECEIPTS <br />'[HIS R~CE:[P'T' <br /> <br />$18_90 <br /> $0.00 <br />$~8.90 <br /> <br />BALANCE DUE <br /> <br /> RECEIVED BY: ¢I ' 'IYPE: CK CHECK ~; 19718 <br /> <br /> * THIS 15 A VALID PEI~IIT * THJS, PEI~I[/:EXPIRE~180 DAY~FRO~I ITS i~E DATE. iF <br />~$TBCTi~ C~ ~R A FAI~ fO REEf ALL <br />~IR~T5 OF STATE ~:~B,~IB:~N~ 8UJBIN6~O ~IN60RDIN~C~, fHIS PEril' <br /> ALL BEdE NULL ~¢~. <br /> <br />REMARKS: GAS P'URN f"~t3047 <br /> <br />[YONALO E. NOOOLEY, MAR[ON COUNTY BUiLDiNG OFFiCiAL <br /> <br /> OFFICE COPY <br />FORM # MC ~¢~,56 REV, 4i~0 <br /> <br /> <br />