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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 />t am performing work on a property I own or occupy. . <br />lam8 regicteredbuilderOR( )theauthorizedrePfe$entat~ve <br />of a registered builder. <br />The WOrk win be performed by a registered builder, <br />Other____ <br /> <br />tills document· <br /> <br />OWNER']DA Tlii ~ 06/17/~4 TIME. <br /> <br />s~tus ^~r~.,I'f ·LAKE .MARINA/HIEBERT · DON <br /> <br /> 115 BREITENBUSH RD -- <br />DETROIT ,, OR_.. ~7_~42 <br /> <br />SIGNATURE OF APPLICANT: <br /> <br /> DETROIT LAKE MARINA <br /> DETROIT. OREGON ~7~42 <br /> PHONE: 854-~423 <br />LOT'~ ...... BLOCK: $'E~ ........ <br /> <br />DATE; <br /> <br /> TAX LO~ <br /> <br />.... ,DETRO,IT/ ....... NO <br /> / <br /> <br /> / V~LUATION~ <br /> <br />· '~CCUPANT LOAO' <br /> <br />TYPE: PLUHBZNG PERHIT OR ~I/~LICATZOH NO." <br /> / <br />CONTRACTOR, NO~ <br />DETROIT LAKE MARINA/HIEBERT <br />DETROIT LAKE MARINA <br />DETRO~,T. OREGON ~?~42 / <br />PHONE: 854-342;~ / <br /> <br />COMMERCIAL ¢IXTORE, NEW <br />PLUMBING BASE EEE / <br />PLUMBING STATE SURCHAR~ <br /> <br />PAYEE: DETROIT MA~II <br />RE~EIYEB BY: <br /> <br /> · TH~S IS <br />FOLLOWIN¢ <br /> LL <br /> <br />90§~9~7 <br /> <br />TOTAL ASSESSEB, FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />BALANCE DUE <br /> <br />~EEN <br /> <br />QUANTITY /'A AMOUNT <br /> ~ / ,~.~.~' $45,00 <br /> '~ $20.0o <br /> $3.25 <br /> <br />$68.25 <br /> $0.00 <br /> <br />INVOICE NO: 58~94 <br />TYPE: IN CHECK ~: 0 <br /> <br /> ~ REVIEW PROCESS WHERE THE <br />FY aF THE APPLICANT TO ASSURE THAT <br /> <br />PLAN RE~ BY DATE <br /> <br />REMAR~ 5 FIXT <br /> <br />JURISDICTION: BY .............. DATE ........................ <br /> <br />OFFICE COPY <br /> <br /> <br />