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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: 888-7904 <br /> <br /> I am performing work on a property I own or occupy. <br /> I am a resistered builder OR the authorized representative <br /> of a registered builder. <br />( ) The work will be pedormed by a registered builder. <br /> <br /> OWNER: :fAX L~f: : CATEGORY: <br /> SMIfEI,~ JAMES ALLEN i RESIDEI'I'I'~(A[.. <br /> <br /> 13470 LAKEWOOD BR NE .COAtRAOTClTY: U~B; OCCUPANT LOAD: <br /> AUR8RA OR ~7882 MARION COUNTY ~140 : <br /> <br /> LAKEWOOD ESATBS NO 1 <br /> <br /> ~ITE NUHBER: 94-~1888 <br />, PHONE: &78-145~ VALUATION: <br /> <br /> 98 201 ~ ~ SF ~ YES NO <br /> <br /> TYPE: HECHANICAL PERHIT OR APPLICATION NO: 9854~8 <br /> <br />CONTRACTOR. NO. <br />SMITHy JAMES ALLEN <br /> <br />PHONE: 678-1450 <br /> <br /> IlEM <br />FORC AIR FURNACE UNDE~ 100008 BTU <br />DON EXHST FANS & DRYER VENTS <br />MECHANICAL BASE FEE <br />MECHANICAL STATE SURCHARGE <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY AMOUNT <br /> $10.00 <br /> <br />$19.95 <br /> $0.00 <br /> <br />BALAMOE DOE $0,,00 <br /> <br />PAYEE: SMITR~ JAMES ALLEH <br />RECEIVEB BY: c~2 ........................................ <br /> <br />RECEIPT NO: 57430 <br />TYPe: CK CHECK ,~: 1618 <br /> <br />FOLLOWING NUST BE CONPLETED. ,iT,'I5 THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />LL NECESSARY IHFORNATION H~S BEEN PROVIDED. <br /> <br /> PLAN <br /> REVIEW: <br /> ~Y <br /> C~I'Y JURISDICTIONS-B? <br /> REMARK~: RELOCATE FURRT-B~T~-FAN <br /> <br />FORM # MO 1 ~-~6 REV. 4/90 OFFICE COPY <br /> <br /> <br />