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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;$0 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />l am a registered builder OR ( ) the authorized representative <br /> <br />The work wild be performed by a reglstered~builder, <br />Other. <br /> <br />OWNER; : TAX LOT: i CATEGORY; <br /> COUf~Ii..F_":,~ V., - '-~ .....~ ' · <br /> Ri:.= tOE, h,] I :~L,. <br />SITUS ADDRESS; : CONSTRUCTION TYPE; I OCCUPANCY; <br /> <br /> :LZ?].;:_~ H ~¢,J=,( L,N NFZ ; CONTRACT CITY; ;UGB; OCCUPANT LOAD'. <br /> AURORA OR 97'~2 ~AR~ON COUNTY ~NO ~ <br />USE OF 8UIgDING; I NO. OF BEDROOM5 <br />MA}LING ADDRESS: ! SUBDIVISION; <br /> <br />TYPE: MECHAMICAL PERMIT OR APPLICATION NO: 9057740 <br /> <br /> ITEM <br />GAS CONNE'CT].ON <br />FORC Ai~f~ FURHACJ.'-' UNDF:R 1000~e BTU <br />OTHER (A~ PER MECHANICAL CODE) <br />MECI,,~AN:[OAt, BASE FEE <br />MECHANICAL STATE SURCHARGE <br /> <br /> TO'FA[_ ',ASSESSED FEES <br /> PRE~IOLIS R'ECEIPT~ ' $22., <br /> $0,, 00 <br /> THi~ .RECE,IF'T $f6,, 00 <br /> BALAMCE DUE $~.;.,, ~.~ <br /> <br /> ........ RECEI :~T !'O: <br /> k:{,,Lt, V~.D BY: l~b TYPE: CHECK 4~::~ <br />* THIS IS NOT A PERMIT, THIS APPLICATION MUST GO THROUGH'A REVIEW PROCESS WHER[ TH~ <br />FOLLOWING MUST BE COMPLETED. ' IT~iS'THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> LL, HECESSA~Y iNFORMATIO~ HAS BEEN PROVIDED. <br /> <br /> F'LAN nEV..,.;/,, BY DATE [ <br /> <br />~ORM ~ M~ 15-58 R~V, 4/90 OFFICE COPY <br /> <br /> <br />