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SENATOR BLDG. NO, 225 <br />220 HIGH STREET NE <br />SALEM1 OREGON 97301 <br /> <br />PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 .~_ ~ <br />, ,,m Re,,ormin,, o,,,, o,,,n o, oo uRy. <br />I am a registered builder OR ( ) the 8uthorized representative $~GNATURE OF APPLICANT[ <br /> <br />Other <br /> <br />this document· <br /> <br />12: 29'.' 17 <br /> <br />..... MC', [ttlLo¥, MICHAEL <br /> SITUS ADDRESS; <br /> <br />......... 22651=J~1 <br /> 2GNSTRuDTION TYPE <br /> <br />MARION COUNTY NO <br /> <br />' CATEGORY; <br /> <br />~I:~ESIDENTIAL <br /> <br /> .... L-RE .E-kkg~- E S-:¢A-T E-S - 44- ............ <br /> SAME <br /> SITE NUMBER: 94-02928 <br /> PHONE: 678.-'J. 448 VAL. UA'/.1;ON: <br />l'cdf; ......... ' ~ L~8'~'. ................ ~ [~r'lS-~ ......... T 8-~V-N-~ ~1 ~1~: ............ R,~ N G-~ ............ I ~'~'~'~; ........ MAP: <br /> <br /> 1PEin-., ' ................ ............... ..........FS'~ ~', ............ "°~ * ...... <br />JWl~fH; <br /> <br />L ...........~.__ _~ ............ ~ ..................................... ~ ........... .~ ~, ~ ~ ................ <br /> <br />TYPE: PLUHBIHG <br /> <br />PERMIT OR APPLICATIDH NO: 9856885 <br /> <br /> ITEM <br />~ESIQENTIAL FIXTURE~ NEW EONS'I, <br />PLUHBING BASE FEE <br />PLU~ING STATE SURCHARGE <br /> <br />TOTAL ASSESgEB FEES <br />PREVIOUS RECEIPTS <br />.'THIS REgEtPT <br /> <br />QUANTITY AMOUNT <br /> :1, $?.00 <br /> $28,00 <br /> <br /> $0,00 <br />$$0,,45 <br /> <br />BALANCE' DUE ~.~0,, 00 <br /> <br /> F'A~EE; Thomas Cyril $cho~s RECEIPT NO: 59~93 <br /> RECEIVED BY: CL., .......................... ~ ................... TYPE: CK CHECK :~: 1565 <br /> <br />· THIS IS NOT A PERHIT, TH~S APPLICATI~ HU~ gO THROUGH A REVIE~ PROCESS WHER[ THE <br />FOLLOWING HUST DE CDHPLETED., IT lis THE RESPONSIBILITY OF THE APPLICANT TO ASSURe THAT <br /> <br /> PLAN REVIEW: BY ................ DATEj .......... ,__ CITY JURISDICTION: BY .................... DATE ................................ <br /> REMARKS: SHOWER <br /> <br />OFFICE COPY <br /> <br /> <br />