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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG NO 225 <br /> 220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> PHONE:: 588-5147 8:00 - 4:30 ~""-?/,~ <br /> 24 HOUR CODE-A-PHONE:: 588-7904 <br /> <br />I am pedorrqu]g work on a progerty I own or occupy <br />I am a registered builder OR the author,zed ropresentatbe SIGNATURE OF APPLICANT <br />O¢ a registered builder, <br />The work will be performed by a regrstered builder <br />Other_ <br />I have read and agree to the terms stated on the reverse side of I~ATE <br />this document <br /> <br /> DALE: 08/09/91 TINE: <br />i owN~ HARR i 5ON H O!v)E~ <br /> <br />13:5):38 <br /> <br /> 11743 WARBLER LANE NE <br />AURORA OR 9?002 <br /> <br />TAX LOT <br /> <br />UGB <br /> <br /> NO <br /> <br />CATEGORY <br /> <br />OCCUPANCY <br /> <br />MAILING ADDRESS SUBDIVISION <br /> <br />CENfURY ~EADOJ~S <br /> <br />13233 SE F4CLOUGHLiN <br />Mi LWAUKi g OR 97332 <br />PHONE: 654-0265 SI'~ P~ NUIV~EIR: 1J~89 <br /> VALUA f iON: <br /> <br /> 2'0 <br /> <br />Rb5 L D~,N [ iAI <br /> <br />MAP <br /> <br />IYPE: PLU~iNG <br /> <br />PbRNiI ON APPLICAf/(~ NO: <br /> <br />CON YRACfQR, NO, 51964 <br />HARRISON HOf'4ES <br />13233 5E [v'/,JLOUGRL[N <br />NILWALJKiE, ORE 9/222 <br />PHONE: 654~0265 <br /> <br />9034372 <br /> <br />ifF---fyi 0UANTiIY A~IOUNT <br />WAFER LINES, 1SI 100 F~E1 1 $20 OC~ <br />SEWER L~N~S, 161 100 FEE1 I $30.00 <br />PLUMBING SI'Af~ 5URCHARGE $2 <br /> <br /> IOIAL AS,,S~SED FEES $b2,50 <br /> PRE¥iOJS RECEIPTS <br /> 'f'Hl8 RECEIPT Sb2,bU <br /> <br /> BALANCE 0UE $0,00 <br /> <br /> PAYEE: HARRISON I'tOf'4ES R~CEiP7 NO: <br /> RbCEiVED BY: Pl~ ~ 1YPE: CK (;;NECK ~: 3351 <br /> <br />¢(]LL~iNG IvlJST BE COMPLETED. I'T IS THE RB~TBIL:I[TY OF 'rile APPLf~T TO ,~C~SURE THAT <br />ALL NEC~RY INI=O,'~IATI~ H.a~ 6.EEN PI;;~IV,[DIED. <br /> <br />PLAN R~VIEN: BY DA'rE <br /> <br />R~IVp. RKS; WA]ER/SEWER LINE5 R~25D? <br /> <br />CifY JURiSDICtiON; BY [IATb[ <br /> <br />............... I ..... ~f FIP. E COPY <br /> <br /> <br />