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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 />lamaregioteredbuilderOR( )theauthorizedrepresentatlve <br /> <br />TMe work will be performed by 8 registered builder. <br />Other_ <br /> <br />YES N0 <br /> <br />TYPE: DWELLIWG PERMIT OR APPLICATIO~ <br /> <br />~8(18 Rockl~dge Ct NE <br />PHOHE~ 390--~861 <br /> <br /> ITEM <br />DNr_LI I1'I(. BU.r._~):r. MG FEE <br />DWELL. 1HG PLUMB [FiG <br /> <br />DWI~],..I. 1N6 ELECTRZCAL <br />D~KL~ (dl~ ~TA~ SIJRCHARI~E <br />DWELLIK(~ FLAN REV~Z~W <br /> <br /> ~544~2 DP <br />ARCHITECT/EN~INtEER~ <br /> <br />PHONE: <br /> <br />TOTAL ASSESSED FEES <br />PREV):OU8 RECEi'F'TS <br />THIS RECEIPT <br /> <br />BALANCE [)LIE <br /> <br />QLJAN'i¢' l TY <br /> <br />AHI}UNT <br />$249. <br />$91. I2 <br />$22,, 70 <br />$7:t, ,, 15 <br />$21.74 <br />$:1,85,, <br /> <br />$641.59 <br />$641,.59 <br /> <br /> $ 0 ,, f~] (ii <br /> ,':'AY!~,?.- . oht~ F r(ieoer 56077 <br /> RI.£,~,~,V:,]~) IY., PM TYPE: :IN CHECK ~: ~ <br /> <br />FOLLOWING MUST BE COMPLETE~. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSU~E THAT <br />LL NECESSARY INFORMATION ~AS BEEN PROV~[~EB. <br /> <br />..... ,-' ..................... TOTAL S,., F'T: ;1,5',"~;2; ¢"'~:' <br />Z, dill& BY trade .................. " Lo ,.~ <br />.L_ ]'.I.C. :(~'( ................................ D~-I'E ............................ STOR~JE~: ~ k, ,, <br /> PLAN.. ACTION: RR-" :1. 4 <br /> ENER(~Y PATH: 8 SF', ........ <br /> <br />L:rTY ,Uk,cDICI'ION,, BY. .................... DAlE <br />r.,...H~,~ x,:,, i,g::l~/ .~ . ~ <br /> <br />FORM # MC 15.5~ REV. 4/90 OF FICE COPY <br /> <br /> <br />