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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 />I am perforf~irlg WOrkOh a property I owr~ or Occupy. ~ / ~ ' \ <br />Iarn a registered bui]der OR ( ) the authorized representative SIGNATUFtE OF APPL~CBNT~~ <br />of a registered builder. <br />The work will be ¢erformed by a registered builder <br /> <br /> Other ....... <br /> I have read and agree to Ihe terms stated on the reverse side of <br /> this document <br />OAf'E: 09/27/9'I T'.[ f4E: <br /> <br /> q0369 C,'HAI'4POEG ROAD <br />AURORA <br /> <br />OR 9'7002 <br /> <br />NE <br /> <br />USE OF BCI[ DING' <br /> <br /> TAX LOT: <br /> <br />CONSTRUCT[ON TYPE; <br /> <br />fv)AR,[ ON COUNTY <br /> <br />, OAT~aORY: RESt OEN'f i~ <br />: OCCBPANCy: <br /> <br />NO <br /> <br />NO 0¢ BEDROOMS <br /> <br />SUBDIVISION <br /> <br /> PHONE: 6'/t¢-'1228 <br />LOt: BLOCK ! SECTION; "¢OWN$~qlP: <br /> <br />SiTE NUI~3ER: 14343 <br />VALUATION: <br /> <br />MAP: <br /> <br />1YPE: I~ECHANiCAL PERMit' OR APPLICATION NO: <br /> <br />coNrRACTOR, NO. <br />MYERS, Pi'f'TERLE (CHAI'4NPOEG ViNE <br /> <br />~HONE: ~"f8-1228 <br /> <br /> i'fE~ <br />~ES'f'iC ~O0O STOVE <br />NECHANiCAL 8A.~E FE~ <br />~ECHAN[CAt, ~'1'AIE <br /> <br />TOTAL A.~ESSEO F~ES <br />PREVZf2USRE~EIP:FS <br /> <br />QUAN'T'II'Y AIV~UNT' <br /> 2 5'15.00 <br /> 510.00 <br /> $ '~. 25 <br /> <br />526.25 <br /> $0.0(;) <br />$,:.6.25 <br /> <br />8tALANCE L,~JE 5(} - 00 <br /> <br />RECEIPT NO: 37521 <br /> <br />PAYEE; MYERS, PI'f'TERLE (cHAIViNp%3EGV~NEYAR¢ <br /> <br /> RECEIVED BY: 0~2 TYPE: CK CHECK <br /> <br />* THJ,~ I$ A VAL/D PER. IT Z ]-HIS PERIVI,[T ~1~ 180 ~ ~ iT~ I~E ~TE_ IF <br />~8T~T~ C~B ~R A PERIO0 OF 180:: ~. OR IF ~STBC~I¢ FAi~ TO M6ET ALL <br />RE~IRB~T8 OF ~TATE ~ ~O ~RI~:; ~N~ :BUI~DI:N6 ~D Z~IN60RDIN~C~, THi3 PE~IT <br />~ALL B~E NULL ~D <br /> <br /> RE~RKS: 2- ~[S'f'iNG <br /> ~:)NALO E. ~OOLEY, ~Ri~ OOUNTY BUlLDIN60FP'iCiAL / BY _.._~. <br /> <br />ron~ ~ ~c ~,-~e REV. 4~ OFFICE COPY <br /> <br /> <br />