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MARION COUNTY BUILDING INSPECTION <br />SENATOR SLDG. 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 />I arll per fO rming workona~rOperty I own o occupy '~ ~'~ ,,~~ <br />I am a registered builder OH the authorized represen ave SIGNATURE OF APPLICANT~ <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 DATE: <br />this document. <br /> <br />AUMoVIL. LE OR 97325 ' <br /> , NO OF BEDROOMS: <br /> <br /> [ <br /> <br /> SZTE NUHBER: <br />PHONE= 749-22~7 VALUATION: <br /> <br />TYPE: MECHANICAL <br /> <br />CON'IRACTOR~ NO. 52209 <br />Wi. llJ. al,~ F Get,grid <br />6947 .gtayton Rd SE <br />?~r'ner,, 97392.,,.8888 <br />FHONE: 769-7695 <br /> <br /> iTEM <br />GAS CONNECTION <br />GAS WATER HEATER <br /> <br />PERMIT OR APPLICATION NO: 6B572 <br /> <br /> MECHANICAL BASE: FEE ~ <br /> HECHANICAI... STA'rE SIJRCHARGE: :,I' . ": <br /> <br />_ ~ THIS IS A VALID PER~I:~ IT8 ISSUE BATE. II ....................... <br />cONSTRUCTiON CEASES FOR FAILS TO MEET ALL <br />EBU[REMENTS OF STATE LAUS QE~INANCES~ THIS PERMZT <br />ALL BECOME NULL ~ND , : <br /> <br /> F~EHARKS: GAS [..Il,rE AND [d~:'~ER HEATER ;FOR ~BTION <br /> DOI,~AJ...I) E., WOODt..EY~ HAR:[O~ COUNTY BUZLD~N~:OFF]:C~L / BY <br /> <br />OFFICE COPY <br /> <br /> <br />