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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 2o5 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: S88-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />of a registered builder, <br />The work wil~ be performed by a registered builder. <br /> <br /> DATE'.', 05/12/~4 T:rHE: 12,~0~.~25 <br /> SMITH, JANE8 ALLEN ~ ~RE~IDENTIAL, <br /> <br /> 1~47B i,,,AKE~OOD DR NE ~-~-6~'~Xd~'~,TY: ; O~ :Cb6Ob~NfCOAO: <br /> AURORA OR 978e2 :MARION BOtJNTY ~NO i <br /> <br /> ' LAKEWOOD ESATES NO 1 <br /> PHONE: 478-145e ~ VALUAI'ZON= <br /> <br />SIGNATURE OF APPLI . <br /> <br />TYPE: PLOHRINC <br /> <br />CONTRACTOR. NO. <br />SMITH~ JAMES AL, LEI~ <br /> <br />PERMIT OR APPLICATIOH HO= 9854956 <br /> <br />PHONE: 678-1450 <br /> <br /> ITEH <br />RESIDENTIAL FIXTURE~ NEW COflST.:: <br />PLUHBING BASE FEE <br />PLUMBIN~ STATE SURCHARGE <br /> <br />QUANTITY AMOUNT <br /> 3 ~27~00 <br /> $20.00 <br /> $2.~5 <br /> <br />TOTAL ASSESSED FEES $49.35 <br />PREVIOUS RECEIPTS $0.00 <br />THIS RECEIPT $49.35 <br /> <br /> PAYEE: SMITN~ JAMES ALLEN' :::: ,::: :: :. RECEIPT NO: 57429 <br /> RECEIVED BY: cl2 ........ =___:_:=,~__ ....... ~,=:~_~ TYPE: CK CHECK ~: 1618 <br />~ THIS [S NOT A PERHIT, :TH:~S ':APPLICATION MUST ~ THROUGH: A REVIEW PROCESS ~HERE THE <br />FOLLOMIflG HUST BE COflPLET~;: 'iT I~':"THE ~SPONSIBiLITY OF THE APPLICAHT TO ASSURE THAT <br /> LL flECESSARY ZMFORHATIOH ,H~S :BE~ PROVIZ,: ~ ~ <br /> <br /> PLAI,! REVIEW: BY ............ =_,~::DATE : CITY JURISDICTION: BY gATE <br /> REMARKS. ~ FIX : ' <br /> <br />OFFICE COPY <br /> <br /> <br />