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MARION COUNTY BUILDING INSPECTION <br />SEblATOR ~DG, 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 />I am performing work orl a property I own or occupy. <br />I am a registered builder OR the authorized representative <br />of a registered builder, <br />The work will be performed by a registered builder. <br />Other <br />I have read and agree to the terms stated on the reverse side of <br />this document. <br /> <br /> (; L ?'_'N LAFRAHCE : iRESZDENTIAL <br /> <br />: 18626 BO'fTEVILLE RD HE <br />; AURONA O~ 97~B2 jMARION COUNTY ~NO <br /> <br /> STTE NUNBER: 74-82949 <br />i FIIONE.-- c781--8:~35 VALUATION: <br /> <br /> ~ ~..~l-..&- .-~C NO <br /> <br />TYPE: HECHANICAL PERNIT OR APPLICATION NO: <br /> <br />CONTRAgTOR~ NO. 78~78 <br /> Oregon H?ating & Lool~,ng <br />F'O Box 4327 <br /> <br />PNOHE: 581-8747 <br /> <br />ITEM <br />HEAl' PUMP ,:, <br />MECHANICAL BASE FEE : <br />ME.HANIgAL STATE SUR,,HARGE: <br />"' :: .' nssESSED FEES <br /> : : PRE~IOUS RECEIPT~ <br /> I:: :,: THIS:, REOEIPT <br /> i <br /> <br />QUANTITY AMO(JNT <br /> 1 $6.00 <br /> $18,00 <br /> $0,, 80 <br /> <br />$16.88 <br /> <br /> $0.00 <br /> <br /> · RECEIPT NO: <br /> RE[.EIVfE:O BY: PM TYPE: gORgE ~- 0 <br /> <br />CONSTRUCT[ON CEASES FOR A PERIOD OF, 18~ ,DAYS~ OR IF CONSTRUCTION FALLS TO NEET ALL ALL BECOHE NULL AND VOI~: ~ <br /> <br /> REMARKS: HP/AC ~ <br /> ~)ONAL, D E,, WOODLEY~ MARION COUNTY BtJIL,I)IN6 OFFICIAL / BY <br /> <br /> OFFICE COPY <br />FORM # MC f ~,56 REV', <br /> <br /> <br />