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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 />lam performing workon a propery own or occupy <br />I am a registered builder OR the au horlzed tee e$en ave SIGNATURE OF APPLICANT: <br /> of a registered builder, <br />The work will be performed by a regisfered bulrder. <br />Other <br />I have read and agree to the terms stated on the reverse side of DATE: <br /> <br /> E 8. a0.=04 <br />,' ~ATHIES~ MICHAEL ; 72651-~11 RESIDENTIAL <br /> <br /> AORO~A OR ~7~2 ~ARION COUNTY :NO <br /> <br /> ~ LAKEWOQ~ ESTATES ~4 <br /> SAHE .......................................... <br /> <br /> PHONE~ &~8-1448 ' VALUATION: <br /> <br /> 176 J 181 SF YES NO <br /> <br />TYPE: NECHANZCAL <br /> <br />COMTRACTOR, NO. 01911 <br />Wolfers <br /> <br />Noodburn, 77071 8880 <br />PHONE: ~81-4511 <br /> <br />PERNIT OR aPPLICATION HO: 58546 <br /> <br /> ITEH <br />OTHER (AS PER MECHANICAL CODE) <br />~ECHANICAL BASE FEE <br />MECHANICAL STATE SURCHARGE <br /> <br />QUANTITY <br /> <br />AMOUNT <br /> $4.50 <br /> $1~,,00 <br /> $0.73 <br /> <br />'TOTALASSE$$ED FEES $15.23 <br />PREVIOUS RECEIPTS $0.00 <br />THIS RECEIPT: $15.23 <br /> <br /> PAYEE: Wolfers Inc :! RECEIPT NO: <br /> RECE~¥ED BY: js ........... TYPE: CK CHECK'¢: 18215 <br /> ; THiS IS A VALID PERHIT I88DAYS FROH ITs ISSUE DATE. IF <br />CONSTRIJcTIoN CEASES FOR ~:PERZ§D oFzoBDA~t~OR::IF:COHSTi~UCTIOH FAILS TO MEET ALL <br /> EOUZRE~EHTS OF STATE AND ZONING ORDINANCES, THIS PERHIT <br /> ALL BECOME HULL AND VOID. '~ : <br /> <br />REMARKS: FURNACE DUCTS : I <br /> <br />DONAL]} E. WQOI)LEY~ MARION COUNTY BUILDING OFFICIAL / BY <br /> <br /> OFFICE COPY <br />FORM # MC t5,56 REV, 4,,t30 <br /> <br /> <br />