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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 - 4:80 <br /> <br />I am performing work on a property I own or oaoupy. <br />I am a registered buitder OR ( ) the authorized reoresentatwe 81CNATURE OF APPLICANT: ., ..¢_~z~.._.. <br />of ~ registered builder, <br />Other ,, ~_ /~ ~.._ ~._~ .......... <br /> <br /> MAILING ADDRESS; SUBDIVISION'. <br /> <br /> SITE NUMBER: <br /> PHONE: 3&~--6~54 VALUATION= <br /> ~'~' ............... ~, .... <br />~ & ~DEPTH: AREA; UNITE IRREG, LOT: ]CORNER: <br />~Sf~,.. ......... ~ ~ ~ ................ ~ ............. - ......... L.~...AR~ ................. ' <br /> <br />L ......................................................... ....... <br /> <br />TYPE= PLUMBING <br /> <br />CONTRACT?~ NO. <br />PEARgE~ CHARLES <br /> <br />PHONE: 363-6954 <br /> <br /> ITEM <br />RESIBENTIAL F[XTURE~ NEW CONST, <br />PLUMBING BASE FEE! <br />PLUMBING STATE SURCHARGE <br /> <br />PAYEE: F'EARRE~ CHARLES <br />RECEIVEO BY: &L <br /> <br />PERHIT OR APPLICATION NO: 9~5~48~ <br /> <br />QUANTITY A~DUN'F <br /> 4 $36,,00 <br /> $20.00 <br /> $2.80 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECE%PTS <br />THZS RECEIPT <br /> <br />$58.88 <br /> ~1~ r,,'L, 00 <br />$58,, 88 <br /> <br />BALANCE ~ DUE <br /> <br />!I~0.00 <br /> <br /> RECEIPT NO: 55944 <br />TYPE: CK CHECK ,~: 4667 <br /> <br />$ THIS IS HOT A PERHIT. ,THISA~PLIC~TIOHHU8T ~0 THROUGH A REV[EW PROCES~ WHERE THE <br />FOLLG~ZNG HUST BE CGHPLETED.' 'IT ~S THE RESPOI'~IBIL~TY OF THE APPLICANT TO ASSU~E THAT <br /> LL NECESSARY ZNFORHATZON HAS ~EENPROVIDED. <br /> -FI.AN REVIEW: BY 9A~E CITY 'JURIS:DICTION: ~Y I)ATE <br /> REMARKS: 4 FIX IN ALTE~ATION OF GArbAGE TO B~D~M~BATHRH <br /> <br />OFFICE COPY <br /> <br /> <br />