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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLOC, NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - <br /> <br /> ( ) . n24 HOUR CODE-A-PHONE:588-7904 <br /> <br />(~(~) , gm a registered buNd er OR ()the authori,ed represent At)va SIGNATURE OF APPLICAN <br />(~:~) ¢~e w%grk win be perfo/med by a registered builder, ' <br />( ) Other_ <br />{ ,~) I have read and aoree to the terms stated on the reverse side of DATE: <br /> <br /> , 07/~/9~1 1 iii. . ?,..!.....;t..¢.. TAX LOT' <br />,OWN6R.~TF,~ "' ,~ . ." . :' :~.. ,:,' <br /> <br /> PF;T:R~ZN, KEN <br /> <br /> 13B?; BROOKSZbE ~1:~ NE ~b~T--RACTC~TY. <br /> ~I,JROR~ OR ~7802 ,H~R..ON COUNTY <br /> <br />............................................... £dm81V~,6'N; .................. <br /> <br />F'HONI~':~ <br /> <br />SITE NUNBER: ?4-82881 <br />YALUATI:ON; <br /> <br />LO"'; i BLOCK: ' ............... ~-~E~'~I ................ ~'~)~h~-F-- ...... RAN(~ ZONE MAP: <br /> <br /> AREA: UNITS [t0 <br />WfDTN: IDEPTH; .............................................. EI~:' -[. bT: .......... 66'~h ............... <br /> <br />TYPE: PLUNBIHG <br /> <br />PERMIT OR APPLICATION NO: 56785 <br /> <br />CONTRACTOR, I,lO. 62.t. 5~J <br /> Molalla F'3, umbing thc <br />PO Box :;,8~ <br />Hola:kla,, 97038-0000 <br />PHONE: 829-2225 <br /> <br /> ITEM <br />WATER LINES. 1ST 100 FEET <br />PLUMBING STATE SURCHARGE <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />BALANCE DUE <br /> <br />QUANTITY AMdUNT <br /> 1 $20,00 <br /> $ :1.00 <br /> <br />$21.00 <br /> $0.00 <br />$21.o0 <br /> <br />$0.00 <br /> <br />CONSTRUCTION CEASES FOR A PERIOD:OF'18~ ~AYSj OR IF CONSTRUCTION FAILS TO MEET ALL <br />EQOIREMENTS OF STATE LA~S AND N~RION COUHTY BUILDING AN9 ZONING ORDINANCES~ THIS PERMIT <br /> ALL BECOME NULL AND VOID. j ' ' <br /> <br /> REMARKS: WATER I,.INE ' <br /> <br /> I)ONAL, D E,. WO[)~I._EY~ MARION OO]N'(Y ~U:[L~IN6 OFFICIAL / BY <br /> <br /> OFFICE COPY <br />FORM # MC 15-56 BBV. <br /> <br /> <br />