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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: 888-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />of a registered builder. <br />The work will be performed by a registered builder, <br />Other. <br /> <br />I have read and agree to the terms stated on the reverse side of <br /> <br />SIGNATURE OF APPLICANTZ <br /> CATE; <br /> <br />Ch'uS A~TdE~;."'~ W'~LFRIED <br /> <br />CONTRACT CIfY UGB <br />HARION COUNTY bio <br /> <br /> 1:2887 CASE' RD NE <br /> AURORA OR 978~_ 2 <br />USE OF BUILDING: <br /> <br />SUBDIVISION <br /> <br />CATEGORY; <br /> <br />OCCUPANT LOAD: <br /> <br />!EOT: <br /> <br />WIDTH; <br /> <br />28178 SASE RD NE <br /> Ro A, OR <br />PHONE: 678,,,,5295 <br /> BLOCK: <br /> <br />SITE HUHBER: 94-~e627 <br />VALUATION: <br /> <br />DEETH <br /> <br />UNI~ ( L~:~G. LOT SC~l~. ¢¢ <br /> <br />5R~ ......AR ..... YFS NO <br /> <br />TYPE: PLUMBING <br /> <br />CONTRACTOR, <br />WI[,,HES,, WI:[.FRIED <br />20178 CASE RD NE <br />AURORA~ OR 97002 <br />PHONE: ~78-5295 <br /> <br />PERHIT OR APPLICATIOH HO= <br /> <br /> ITEE <br />RE--LOCATEO RES:~OENCE FIXTURE <br />PLUMBING BASE FEE <br />PLUMBING STATE SURCHARGE <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />TH~S ~ECEIF'T <br /> <br />QUANTITY AMOUNT <br /> 5 $22.50 <br /> $20~00 <br /> $2,,i~ <br /> <br />$44,63 <br /> <br />~ALANCE DUE $0.00 <br /> <br />F'AYEE: REI,,ETI f NO: <br /> <br /> * THIS IS A VALID PERHIT ~: THIS PERMIT EXPIRES 188 DAYS FRON ITS ISSUE DATE. iF <br />CONSTRUCTION CEASES FOR APERIOD OF18~DAYS, OR IF CONSTRUCTION FAILS TO HEET ALL <br /> EQUiRENEHTS OF STATE LAMS AHD ~ARION COUNTY BUILDING AND ZONING ORDINANCES, THIS PER~IT <br /> ALL BECOHE HULL AHD VOID. <br /> <br />REMARKS: RELOCATE 5 FIXT <br /> <br />DONALD E. WOODLEY, MARION COUNTY BUll. DING OFFICIAL / BY <br /> <br /> OFFICE COPY <br />FORM #MC ~5 58 REV, 4/90 <br /> <br /> <br />