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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 /> SIGNATURE OF APPLrcANX~ <br /> <br /> I am performing work on 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 CATE: <br /> this document. <br /> <br /> DATE: 12/12/94 'r I~.]E r, <br /> <br />SITUS AeORESS'. ~ CONSTRUCTION TYPE: <br /> OCCUPANT LOAO; <br />'USE OF BUIL~IN~; <br /> <br />916 N B~RCH C/O DENNI.~ OL, SON i .......................................... <br />STAYTOI,I~ OR. 97383 SITE NUNBER: 94=~46~I <br />PHI:~N E," 769-5~88 ~ <br /> , VALUATION~ <br /> <br />TYPE: PLUMBING PERMIT DR APPLICATION NO.- 9860183 <br /> <br />CONTRACTOR,j NO. <br />CNORCI4 OP GOD OF PROPHECY <br />~16 N BIRCH C/O DENNIS OI..SON <br />S fAYTON~ OR. <br />PHONE~ <br /> <br />WATER LINES. 1ST 108 FEET <br />PLUHB~N6 STATE SURCHARGE <br /> <br /> TOTAL ASSESSED FEES <br /> PREVIOUS RECEIPTS <br /> 'rHzs RE[;E~PT <br /> <br />QUANTITY AHOUN'I' <br /> 1 ~20,, 00 <br /> $1 ,, BE, <br /> <br />$21,, 00 <br /> i~.0 ,, 00 <br />$ ~,,;t. 00 <br /> <br /> :BALANCE DUE : 'J;O. 00 <br /> PAYEE." ILK OLSON CONSTRUC,:flfJN <br /> RECEIPT NO: 62785 <br /> RECEJ:VED BY: js TYPE: CE CNECK :~.- S:L24 <br /> <br />FOLLOWIN~ flgST BE ~OMPLETE~ = l~ ,IS.THE RESPBHSIBILITY OF THE APPLICANT TO ASSURE TNAT <br /> LL NECESSARY IHFORMATIQN FI~5 BEEN PROVIDE~.: <br /> <br />F'LAN REVIEW: BY : DATE <br />REMARKS: 1,11.,, <br /> <br />CITY JUR I S!):[CT I OI,h: BY ................ I)A 1-E .............................. <br /> <br />OFFICE COPY <br /> <br /> <br />