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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: 088-7904 <br />I am performing work Of/ a property i own or occupy, /,,~),¢~,~.~; p,/]... ~ ~ ¢ . , <br />I am a registered builder OR ( )the authorized representat/ge S GNATURE OF APPL CANT:~~ /[~~ <br />of a registered builder, <br />The work wiH be performed by ~ registered builder. <br />Other <br />I 1~sve read and agr8o to the terms stated on the reverse side of DATE: <br />this document. <br /> <br />'~-I~E.~ ¢~.' 0~ 0~, TAX LO¥: CATEGORY: <br /> <br /> 19887 CASE RD NE <br />AURORA OR ~7002 MAR!BI,! COUNTY NO <br /> <br />20178 CASE R~ NE <br />AURORA~ OR 978~2 SiTE NUNBER: ~4-~27 <br />PHONE: &78-52~5 YALUATIOH: <br /> <br />TYPE: HECHAHZCAL PERMIT OR APPLICATION NO: 985Z~lZ <br /> <br />CONTIr(ACI'OR, ~0. <br />WILHES.~ WIL. FRIED <br />20178 CABLE RD NE <br />AURORA,~ OR 970~2 <br />PliONE: 670-~$29o <br /> <br /> ITEM <br />FORC AIR FURHA~.E UNDER 108000 BTU <br />HECHAI,IICAL BASE FEE <br />MECHAN~.CAL STATE SURCHARGE <br /> <br />TOTAl.. ABBESSEQ FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANT I TY AMOUNI' <br /> 1 $6.00 <br /> $1.0.00 <br /> $0.80 <br /> <br />$16,80 <br /> $0.00 <br />$16.80 <br /> <br />BALANCE DUE $0.00 <br /> <br /> PAYEE: WILFRED WILHES · RECEIPT NO: 56377 <br /> 7a5,,~ <br /> RECEIVED BY: '~ TYPE: CK CHECK ~: ~-= <br />~ ~ ~8 ~T A P~?~ T~ APPL~,CAT~OR H~T GO THROUGH A REVIE~ PROCESS N~ERE THE <br />FOLLOW[NS HUST ~E CONPLETED*: IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> LL NECESSARY IHFORHATION HASBEEH PROVI:OEg, <br /> <br />PLAH REVIEW: BY DATE <br />REMARKS: F/A FURH <br /> <br /> OFFICE COPY <br />FORM #;~4C 16,56 REV. 4/90 <br /> <br /> <br />