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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: 585-5147 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> I am per o fA ikl~o~n petty I own or occupy. <br /> <br /> of a regis: uilder, <br /> O herThew°rk~e~erf°r~~dbyar ' eredbuilder. <br /> <br />uA[fi: 04/~/~2 II,E: <br /> <br />TAX LOT <br /> ?O551191 <br /> <br />CATEQORY <br /> <br />OCCUPANCY <br /> <br />RES.~ OEN[' ][AL <br /> <br />USE OF BLJ~LDING <br /> <br />OCCUPANT LOAD <br /> <br /> kl0 OF BEDROOMS <br /> <br />LOT <br /> <br />WIDTH <br /> <br />CfiN RUFCY VifiAGOrjI,N~ 'q04 <br /> <br />TYPfi: PLUMBING <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CON'f'RAC[OR, NO. '/3977 <br /> LAMA1N CONSTRUCTION <br />208 SE 4'I'M <br />FRCU }'DALE, 97060'~0000 <br />PHONE: ?80-7?36 <br /> <br />9039535 <br /> <br />Il'EM QUAN'I'I'['Y AMOUNT <br />NA'f'ER LINES. 1S'f' 100 FEEl <br />SEWER LINES, 1ST 100 FEET '! $30_00 <br />PLUMBING S'['A'f'fi ~SURCHARGE $2,50 <br /> <br />PAYEE: JOE GREEN <br /> <br />TOTAL A~SE~ED FEES <br />PREVIOUS RECEIPTS <br />THiS RECEIP]' <br /> <br />$52_50 <br /> $0.00 <br />$52.5o <br /> <br />BALANCE DUE $0,00 <br /> <br />RECfilP'l' NO: 41584 <br /> <br /> RECEIVE0 BY: CL 'TYPE: OK CHECK ~t ?40 <br /> <br />~ THiS iS NOT A PEf~"IIT. THiS APPLICATION IvLIST GO THROUGH A R~[EN PROC~ ~ERE THE <br />FOLLOWING MUST BE C~PLETED. IT iS THE RESPONSIBILITY OF THE APPLICANT TO A~SURE THAT <br />ALL NECESSARY INFOR~ATiON HAS BE~N PROVIDED. <br /> <br />PLAN RE¥iE~: ~Y .................................. DA'rE ........................................... <br /> <br />CiTY JURiSOiC'flON: BY ........................... DA'f'E ........................ <br /> <br />REiV~.RKS: WL SL <br /> <br /> OFF:CE COPY <br />FORM # MC ~ 5-56 REV, 4/~o <br /> <br /> <br />