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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 />lam performing work Dna Droberty I own or occupy, T'~~ <br />I am a registered builder OR ( ) the authorized representative SIGNATURE OF APPLICAN~~ <br />of a registered builder. <br />The work will be ~>erformed by a registered builder, <br />I have read and 8urea to the terms stated On the reverse side of DATE; <br />this document, <br /> <br /> / TAX LOT: RESII)ENTIAL :! <br />i OWN~: DA ) E 08/03 / 9 ~ I ~ E; [ .-~ = ..~1 ...................................... ~f[E.O~V~ ~ <br />: ~SCHKE~ LES & ~ETTY <br /> ! ! <br /> AURORA OR 778~2 , <br /> <br /> ........... <br />2201 N MENZZES <br />PORTLAND. OR 97217 MOBILE 799-11~8 SITE NUNBE~: <br />PHONE: 289-&96~ VALUATION: <br /> <br />TYPE= PLU~BiHG PERHTT OR APPLICATION HO= 9848845 <br /> <br />CONTRACTOR~ NO. <br />MASCHKE. LES & BETTY <br />2281 N ~ENZIES DR <br />PORTLAND. OR ~7217 HOBILE 7~-1 <br />PHONE: 289-6%2 <br /> <br /> ITEM <br />WATER LINE~, 1ST 188 FEET <br />SEWER LINES. 1ST 188 FEET <br />PLUHBIN6 STATE SURCHARGE <br /> TdTAL :ASSES~E~: FEES <br /> · ., :PREVIOUS RECEIPTS <br /> :':': ::' ~::: THIS ~RE~E [ <br /> <br />PAYEE.. HASCHkE. LES BETTY <br />RECEIVE9 BY: PM ~ <br /> <br />QUANTITY AMOUNT <br />1 ,.I;20, ~0 <br />1 $30,00 <br /> $2.50 <br /> <br /> ~ THIS iS HOT A <br />FOLLO~IRC HUST BE <br /> LL NECESSARY <br /> <br /> BY DATE _ <br /> PLAN <br /> REVIEW: <br /> BY <br /> <br /> REMARKS: 60' WL~ 60' SL APPROX <br /> <br /> $52~58 <br /> $0.00 <br /> <br /> RE EI T NOAc, <br /> TYPE: CK ~. ~400 <br /> <br />A REVIEW PROCESS WHERE THE <br />THE APPLICAHT TO ASSURE THAT <br /> <br />FORM # MC 15-56 RSV, 4pJO OFFICE COPY <br /> <br /> <br />