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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 />I am performing work on aproperty 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 bultder, <br />Other_ <br /> <br /> P.O. BOX 65~ i <br /> <br /> PHONE~ 263-1993 ' <br />LOT: ........................................................................... ¢ ~LOCK; ~OECT ON'. ! TOWNSHIP: ~ I' RANGE: <br /> <br />TYPE: PLUMBING <br /> <br />PERMIT 0~ APPLICATION H0: 6~5~8 <br /> <br /> ITE~ <br />I](]MHERCIAL FIXTURE:,, NEW CONST <br />F'I,.~JNBIN6 BASE FEE <br />PLUMBING STAf'E' SURCHARGE <br /> <br />'toTAL SSI-:SSE;O F'Er.'¢ <br />F' svI0US <br /> <br />QUAN'FIT¥ AMOUN'F <br /> 4 <br /> $20.00 <br /> $2,,00 <br /> <br />$58.00 <br /> <br /> : , TH:r~ RECEIPt' <br /> <br /> ]~AL~NgE ~UE $0 ,, 00 <br /> I; ~Ytr,i:; Canby ~ lul,lb.~.llq I~c - INVOICE NO~ <br /> RECEIVE~ <br /> DF <br /> ................ " .......................... = .................. TYPE~ IN 6HECK <br /> <br />'ALL BECD~E NULL AN~ VOID. D: A~iQH COUNTY BUILDIN6 AND ZONING ORD~NANCE8~ THIS PER~IT <br /> <br />,~E. ARKS: 4 NEW P"IXT <br /> <br />I)OI.IAI,,D iii:,, W00I)LEY, HARIOh cOIJIIFY BIJILI)]:IqG OFFICIAL / BY ............................................................................ <br /> <br /> OFFICE COPY <br />FORM # MO 15-58 ~EV, 4/90 <br /> <br /> <br />