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MARION COUNTY BUILDING INSPECTION <br />$~NATOR 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 />am performiI3g work on a property ~ own or occupy. <br />am a registered builder OR ( ) the authorized representative SIGNATURE OF APPLICANT; <br />of 8 reglstered builder, <br /> <br /> have read and Agree to the terms stated on the reverse side of OATS: <br /> <br /> BRAND'r~ ROB_ ; ~ESIDEN~ .[AL. <br />~ AURORA OR 97002 NAR~ON COUNTY ~O <br /> <br />'~mL~Ne <br /> <br /> ~ ~ITE NUMBS: 94-B3~8 <br /> PHONE: i VALUATION: <br /> <br /> ~ AREA; <br /> <br />NO OF 969R0OMS: <br /> <br />TYPE.- HECNAN'ECAL PERH'[T OR APPLZCAlriON I~D= .~k9654 <br /> <br />CONTRACTOR~ NO, 94882 <br />RUSS biOBLE NATURAL GAS SPECIALI <br />5424 SE 64TH <br />PORI'LAND~ ?7206 <br />PHONE: 777-7~4~ <br /> <br /> ITEM <br />DOMESTIC WOOD STOVE <br />MECHANICAL BASE FEE <br />MECHANICAL STATE SORCHARGE <br /> <br />QUANTITY AMOUNT <br /> i $7.50 <br /> $10.08 <br /> $0.88 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$18.~8 <br /> $0.00 <br />$18,,~8 <br /> <br />BALANCE SUE $0.0~ <br /> <br /> PAYEE: RUS$.NOBL~RALGA$ SPECIAEIST RECEIPT NO: 612)4 <br /> ~ECEIVED BY, J~~ .... j ..................... TYPE=' CK <br /> <br />CONSTRUCTION CEASES'"F~R-~ PERIO~ ,l[}F '~8~_~, OR',ZF:CONSTRUCTION FAZES TO H/ET ALL <br />EOO~RE~EHTS OF STATE LA~S AN~ HARMON COUNTY'~[L~NGAND ZONING ORg~NANCES~ THIS PERHIT <br />ALL ~ECOHE NULL AN~ VOID. <br /> <br /> OFFICE COPy <br /> <br />FORM # Md 15-¢~ REV, 4fi~O <br /> <br /> <br />