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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREFT NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: S88-5147 8:00 ~ 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am 8 re?.is, tePed builder OR ) the authorized representative <br />Other~ <br /> <br />SIGNATURE OF APPLICANT: <br /> DATE: <br /> <br />OWNER; DATEI; 0~)/0;~/93 TI.ME: ,14:.2&.~,.17 it×~<.£6¥; ,CATEGORY: <br />' BE~K ~ C~ARLES RESIDENTIAL <br />SITUS ADDRESS; ~ CONSTRUCTION TYPE; ~ b~'~0~X~CY: <br /> <br /> 11596 ~RQ{JSE gN N~ : CO~m~CT C~V ugh; , OCCUPanT ~O*O: <br /> AORORA OR 97~82 HARIOH COUNTY; NO <br /> <br /> ....................................... l sueo~visioN; ........................................ <br /> <br /> ....... . $2 <br /> SANE <br /> SITE NUMBER: 9~-~3~$1 <br /> PHONE: &78-52~7 VALUATION: <br /> <br /> I bLOCK; <br /> <br />¢ 58 i 75~ 4358. i SF , NO I YES <br /> <br />TYPE: MECHANICAL <br /> <br />CONTRACTOR. NO. <br />BROCK, CHARLES <br />SANE <br /> <br />PHONE: 678-5287 <br /> <br />PERNIT OR APPLICATION N0: 9e49655 <br /> <br /> ITEN <br />OTHER (AS PER NECHANICAL CODE) <br />NECHANICAL BASE PRE <br />NEOHANICAL STATE SURCHARGE <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY <br /> <br />AMOiJNT <br /> $~.08 <br /> $1L80 <br /> $8.65 <br /> <br />$13.65 <br /> $0.00 <br /> <br /> · ' BALANCE DUE $8.00 <br /> PAYEE. BROCK, CHARLES : RECEt~T NO: 52814 <br /> RECEIVE~ ~Y: NB .... L__= ........... :' :~":~L":'; TYPE: 'CK CHECK ~: 619 <br />~ THIS IS NOT A PE~ZT. THIS APPLICATION i~UST ~0 THROUGH A ~EVZE~ PROCES~ ~HE~E THE <br />FOLLOWING HUST BE COHPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> LL HECESSARY INFORHATION H~S DEEH PROVIDED· <br /> <br />PLAN REVIEW: BY BATE <br />REHARKS: DRYER VENT <br /> <br />OFFICE COPY <br /> <br /> <br />