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MARION COUNTY BUll_DING INSPECTION <br />SENATOR BLOC, 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 />I am performing work on a property I own or occupy. <br />I am a reoislered builder OR ( ) the autl~orl~ed representative SIGNATURE OF APPLICANT <br />Of a registered builder. <br />The work will be performed by a reoistered builder, <br />Other_ <br />~ have read and agree to the terrns staled on the reverse side of BAYE: <br />this document. <br /> <br />OWNER: DAI'E." 04/~fd/94 <br /> <br />, SITUS AI~I~ERL~: ~ ~ ~J 'r LFR I E~ <br /> <br />TIME: 9:09:16 <br /> <br />TAX LOT; :CATEGORY: <br /> <br /> 19887 <br />USE o~ BOIL~m~?CCNR <br /> <br />97002 PIARION COUNTY; N0 <br /> <br />~AILING AD D F~': <br /> <br />L. OT: <br /> <br />20178 CASE RI) NE' <br />AtJRORA~ OR 9~002 <br />PHONE,I 678-3295 <br /> 8LOCK: <br /> <br /> SITE HUMBER: 94-88627 <br /> YALUATION: <br />SECTION; TOWN~H IP'. RANGE; ~ONE: MAP~ <br /> <br />TYPE: PI.UflBIHO <br /> <br />PERMIT UR APPLICATION NO-- ?05~?14 <br /> <br />CONTRACTOR. ~0,, <br />NILMES,, N I I:..Fk.T. El) <br />20178 CASE RB NE <br />AURORA, OR ~7002 <br />PHONE." ~78-5295 <br /> <br /> ITEM <br />RE-LOCA'I'EB RESII)ENCE FZXTURI~ <br />PLUMBING BASE FEE <br />PLUMBING STATE SURCHARGE <br /> <br />TOTAL ASSESSE~ FEES <br />PREVIOUS REOE~PTS <br />TH~S RECEIPT <br /> <br />BALANCE f)~L1E <br /> <br />QUANTITY <br /> 5 <br /> <br /> AHOUNT <br /> $22.50 <br /> $20.0~ <br /> $2.,1~ <br /> <br /> $44u~ <br /> $0.00 <br /> $44.63 <br /> <br /> 56378 <br />CHECK ~: 7555 <br /> <br /> PAYEE: WILF'REI) WIL,HES RECEIPT NO: <br /> RECEIVED BY: PH2 ................................... ~ .... TYPE: <br /> <br />$ THIS IS WOT A PERMIT. THIS APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST BE COHPLETED. IT IS THERESPORSIRILITY OF THE APPLICANT TO ASSURE THAT <br /> LL NECESSARY INFORMATION HAS BEEN PROVIDED. <br /> <br />PI,,,AN REVIEW:i BY ~)ATE <br />REMAFd(S: RELOCATE 5 F:[XT <br /> <br />CI'I'Y JURISDICT:fON: BY <br /> <br />DATE ........................... <br /> <br />OFFICECOPY <br /> <br /> <br />