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MARION COUNTY BUILDING INSPECTION <br />SENAT,,OR BL'DG. 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 />lam 8 registered builderOR( ) the authorized representative <br />of a registered ~uilder, <br />The work will be performed by a registered builder. <br />Other. <br /> <br /> DATE: 07/16/90 'f'ilvlE: 73:48:46 <br /> HEWI'T' f' , DEL <br />SITUS ADDRESS; <br /> <br />SIGNATURE OF APPLICANT: <br /> DATE; <br /> <br />' TAX LOT; <br /> <br />i CONSTRUCTION TYPE: <br /> <br />RESt0EN'IIAL <br /> <br /> 13?93 ElqLEN RD NE ; UONTR,,,C~ C,TY; ;'UGB: <br /> AURORA OR 9?002 ','~'&"'RION <br /> C,~N'i'Y <br />USE OF BUILDING: <br /> <br />NO <br /> <br />OCCUPANT LOAD: <br /> <br /> NO OF PFDR00MS <br /> <br />MAILING ADDRESS: <br /> <br /> PO BOX 8?5 <br /> Ni~ViLLE OR 9?0?0 <br /> PHONE: 694.-5109 SiTE NUMBER: 3553 <br /> VALUAT I ON: <br /> <br />LO~: SLODK: : SECTION: ' TOWNSHIP: RANQEJ <br /> : I 1 4~ 1~ EFU <br />WIDTH: 'DEPTH: ' AREA: , UNITS: IR'~EG. L0+~ CORNE~: <br /> NO NO <br /> <br />MAP: <br /> <br /> 3 <br /> <br />TYPE: PLUrVlBZNG <br /> <br />PER~I'F OR APPLiCATiON NO: 25235 <br /> <br />CXgNTFb&C'T'OR, NO. <br />HEN['r'r, DEL <br />PO BOX 875 <br />W~L~,:GO~ViLLE OR 970?0 <br />PHONE: 694-5109 <br /> <br />WATER LiN~, lS'r 100 FEET <br />SEWER LINES, 1Sl' 100 FEEl' <br />MOBILE HOCaE SEWER AND latTER CONNECTION <br />FLEET SURCHARGE -ZONE 8 <br />PLUMBING STATE E~JRCHARGE <br /> <br />QUANI'ITY AIv~UNf' <br />1 $20.00 <br />1 $30.00 <br />I $25_00 <br /> <br /> $~,75 <br /> <br />TOTAL ;A,.%.~ED FEE~ <br />PRE¥iOL~ RECEIPTS <br />THiS RECEIPT <br /> <br />I86.4~ <br /> 86.43 <br /> $0.00 <br /> <br />BALANCE DUE $0-00 <br /> <br /> PAYEE: RECEIPT NO: <br /> RECEIVED BY: PR 'I'¥PE: CHECK ~: 0 <br /> <br /> ~ THiS IS A VALID PEi:~iT ~ PE~[t:E~XPIRE~ 180DAY~ FROIVl iTS lEx..'AJE DATE. IF <br />CONSTRUCTION CEA.S¢:"~ POR A PERIOD OF 180 DAYS, OR iPCONSTRUCT[QN FAII...~ TO MEET ALL <br />~RE~LiRE~E~T$ DP STATE ~ ANDI%~ARION COUNTY BUILDING ANDT.~N-.[~GORDiNANCE~, THZ$ PER~4iT <br /> L BEcOf4E NULL AND VOID. <br /> <br /> OFFICE COPY <br />FORM # MC 15.56 REV. <br /> <br /> <br />