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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 />I am performing work Off a property I own or occupy <br />I am a registered budder OR f I the authorized reprosontative <br /> <br />Other. <br /> <br /> f have read and agree to the term8 stated on the reverse sido of <br /> <br /> ~rE: 12/19/90 rIME: 13:40:40 <br />OWNER <br /> DECO~ I'A, JiM <br /> <br />SIGNATURE OF APPLICANT <br /> DATE <br /> <br /> TAX LOT <br /> <br /> CONSTRUCTION TYPE <br /> <br /> 11190 ~LEN RD NE <br />~RORA OR 97002 <br /> <br />USE OF BUILglNG <br /> <br /> CONTRAC/ CiTY UGB <br />¢4ARION COUN IY NO <br /> <br />11424 EHLEN RD NE <br />AURORA, OR 9?002 <br />PHONE*. 678-1764 <br /> <br />LOT BLOCK SbCT~ON TOWNSHIP <br />17 <br /> <br /> ?. <br /> <br /> .511E NU~ER+. <br /> VALUA r I ON: <br /> <br />4S <br />AC YES <br /> <br />CATEGORY <br /> <br />OCCUPANCY <br /> <br />OCCUPAN~ LOAD <br /> <br /> 11638 <br /> <br />ZONE MAP <br /> EFU 4 <br />NO <br /> <br />CON TRAC fOR, NO. <br />O~iA, JIM <br />11424 EHLEN RD NE <br />AURORA, OR 97002 <br />PHOWE: 678-176~ <br /> <br />PERM['[ OR APPLiCATiON NO: <br /> <br /> il'EM <br />HEA'~ PUMP <br />oor~F.~i[c RANGE HC~)D <br />~ E;x]-Isr FANS ~x ORYER <br />¢4ECHANICAL B~.SE FEE <br />FLEET SURCHARGE -ZONE <br />~lr-CHANiCAL S'fA'I E ~JRCHAR~E <br /> <br />PAYE[: <br /> <br />28865 <br /> <br />7ORAL ASS~ED FEES <br />PREViOUs RECEiPIS <br />THIS RECEIPT <br /> <br />QUANf~T'Y AMOUNY <br />1 $6~00 <br />1 $4.5U <br />$ $~5.oo <br /> $1o.oo <br /> $7.68 <br /> $~.78 <br /> <br />¢444-90 <br /> 4.96 <br /> $0.oo <br /> <br />BALANCE DUE $0.00 <br /> <br />RECEIPT NO: <br /> <br /> R~EIVED BYt Pr TYPE: CHECK ~: <br /> <br /> THIS IS A VALID PERMIT * THiS PERI,lIT ~XPiRES 180 DAY~ FROM ITS I~E ~TE. IF <br />~S"I'~CTi~ C~ ~R A PERIOD OF 180 ~, OR IF ~ST~T[~ FAi~ ~0 MEET ALL <br />R~IR~'TS OF STATE <br />~ALL 8~E NULL ~O <br /> <br />REMARKS: HP, RH, FN, VNI r.~1~3043 <br /> <br />LXJNALO E. ~'¢30OLEY, MARION COUNIY BUILDING OFFiCiAL / BY <br /> <br /> OFF[CE COPY <br />FORM # MC 1 ~-56 REV 4/90 <br /> <br /> <br />