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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 />,am performlm-lworkona ~ropertylown oro¢¢upy. ~ '. <br />I am a registered builder OR ( ) the authorized rePre.entative " SIGNATURE OF APPLICANT <br />Of a registered builder. <br />The work will be pedormed by a registered builder. <br />Other_ <br />I have read and agree to the terms stated on the reverse side of DATE; <br />this documonL <br /> <br /> DATE: io/l~/e2 <br /> OWNEA; <br /> WINGER'FER, DOROTHY <br />' SITUS AObRE~$; <br /> <br />. TAX LOTZ i CATEGORY; <br /> 56514-000 , RESIDENTIAL <br /> <br /> 11722 STEINKAMP RD SE ....... S~,~ ;66COPA~Y LOAD: <br />AUNSVILLE OR 97325 i HARION COUNTY: NO : <br /> <br />LOT; <br /> <br />WIDTH: <br /> <br /> SITE NUMBER: 92-03625 <br />PHONE: 749-3362 ~ VALUATION: <br /> <br /> ~ 88 ; ZW :~ ~N <br /> ;DEPTH; AREA; . UNITS; IRREG. LOT: CORNER: <br /> 2.57 ; ~C ~ NO NO <br /> <br />MAP: <br /> <br /> 48 <br /> <br />TYPE: PLUMBING <br /> <br />CONTRACTOR, NO. <br />WINSERTER, DOROTHY <br /> <br />PERMIT OR APPLICATION NO: 904~158 <br /> <br />PHONE: 749-3362 <br /> <br /> ITEM ~UANTITY <br />WATER LINES, 1ST 100 FEET <br />WATER LINES, EA. ADDL. ZOO FEET 1 <br />PLUMBING STATE SURCHARGE <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />BALANCE DUE <br /> <br />AHOUNT <br /> $20.00 <br /> $15.00 <br /> $1.75 <br /> <br /> $56.75 <br /> $0.00 <br /> $36~75 <br /> <br /> $0_00 <br /> <br /> PAYEE: AL THOMAS CONST. ACCOUNT ~ -/ RECEIPT NO" aReXR <br /> RECEIVED BY: OH2 ................... ~ ........... TYPE: OK ~HECK ~40 <br /> <br />* THIS I8 NOT A PERMIT. THIS APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING HUST BE COMPLETED. ~T IS THE RESPONSIBILITY 0F THE APPLICANT TO ASSURE THAT <br />LL NECESSARY INFORMATION HAS BEENPROVIDED. <br /> <br />PLAN REVIEW: BY ........... DATE ............. <br />REMARKS: WATER LINE <br /> <br />CITY JURISDICTION: 8Y ............. DATE <br /> <br /> OFFICE COPY <br />FORM # MC I ~-~6 REV, 4/~0 <br /> <br /> <br />