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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NC <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I have read and agree to the terms stated on the reverse side of <br />this document. <br /> <br /> OWNER;I)A'I'~'i~: 07/:i. 3/74" TIi~i.F..-.; ..... I2.~"~"~,. 24 TAX LOT: <br /> <br />. MODI)ERN BUiLDING.S~STEES,. INC <br />: SITUS ADD~ESS: CONSTRUOT~ON TYPE: <br /> <br />CATEGORY: <br /> <br />COHNEF~CIAL <br />OCCUPANCY: <br /> <br /> ', '66N~IRXC¥ ~i~; [ ~g: ' OCCUPANT LOAO: <br /> 94~3 PORTER RD SE <br />AJMSVILLE~ OR 97325 :MARION COUNTY ~NO <br /> <br />VAILING AOO~ESS; : sum~o'IVISlON: <br /> <br /> KENNETH, A RASMUSSEN, P.E. 682-1422 . <br /> PO BOX 250 TUALATIN, OR 97~2 ' SITE HUMBER: 94-~2747 <br /> PHOIqE: 747-.474~ VALUATION: <br /> <br />WIDTH; Derail: i A~EA: j U~ ~G. LOT C~ <br /> <br />TYPE: HECHANICAL PERHIT OR APPLICATIOH NO: 47376 <br /> <br />CONTRACTOR, NO~ <br />MODDERN BUILDING,SYSTEMS, INC <br />KENNETH A RASMUSSEN, P~E. ~82-1 <br />PO BOX 2~0 TUA[.ATIN~ OR 970&2 <br />PHONE: <br /> <br /> ITEM <br />F'ORC AIR FURNACE UNDER 180800 BTU <br />MECHAN:[CAL BASE FEE <br />MECHANICAL PLANS gEVIEW <br />MECHANICAL STATE SURCHARGE <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS. RECEIPT <br /> <br />BUAHTITY AMSONT <br /> I $6.00 <br /> $10.00 <br /> $4.00 <br /> $0.80 <br /> <br />$20.80 <br />$20.80 <br /> $0.00 <br /> <br />BALANCE DUE $0=00 <br /> <br /> PAYEE: RECEIPT NO: <br /> RECEIVED BY: DM .......................................... TYPF: CHECK ~: 0 <br /> <br /> ~ THIS IS A VALID PERHIT ~ TH~S PERNIT EXPIRES 188 DAYS FROH ITS ISSUE DATE. IF <br />CUHSTRUCT[ON CERSES FOR A PERZ0D~UF ~8~ ~YS~ OR ~F CDNSTRUCTION F~[LS T~ MEET ALL <br /> EQUIREHEHTS OF STATE L~S ~ND H~RIOH COUNTY BUILDING AND ZONIN6 ORDIHANCES~ THIS PERMIT <br /> ALL BECOME NULL AND VOID.' <br /> <br /> REMARKS. 1 FURNACE <br /> <br /> ~ONALD E. WOOI)LEY~ MARION COUNTY BUILDING OFFICIAL / BY ..................................................... <br /> <br />OFFICE COPY <br /> <br /> <br />