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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 /> <br />I am a registered builder O~ ( } the authorized representative <br />of a registered builder, <br />The work will be performed by a reglstereg builder. <br />Other <br /> <br />I have read and agree to the terms stated on the reverse Side of <br /> <br /> CONTRACTOR, NO. <br /> GRAY, WILL. <br /> 8778 CASCADE HWY NE ' <br /> 8ILVEETQN OR 77381 I <br /> PHONE: 873-7157 '""' J <br /> <br /> ITEM : <br />' WATER LINES. 18T 100 EEET <br />PLUMBING STATE SURCHARGE i~ <br /> <br />PAYEE: Herbert C <br />RECEIVED BY: MB <br /> <br /> $ THIS IS HOT A <br />FOLLDWIHG NUST BE <br /> lL NECESSARY <br /> <br />PLAN REVIEW: BY <br /> <br />REMARKS: WATER LINE <br /> <br /> QUANTITY AMOUNT <br /> 1 $20.00 <br /> $1.00 <br /> <br /> $21.00 <br /> $0.00 <br />,!: $21.00 <br /> <br /> RECEIPT NO: 57536 <br />..: TYPE: CK OHECI( ~: ~551 <br /> <br /> REVIEW PROCESS WHERE THE <br />THE APPLICANT TO ASSURE THAT <br /> <br />CItY JURISDICTION. BY' __.___ <br /> <br />DATE <br /> <br />OFFICE COPY <br /> <br /> <br />