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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 <br /> CODE-A-PHONE 4:30 RM. - 8:00 A,M, <br />, am pedo,~ir~(i work On 8 property I own or occupy, ~,~~~ : <br />I am ~ registered builder OR ( ) [he authorized representatwe SIGNATURg OF APPLICANT - ' <br />of a registered builder, <br />The wO¢~ will be performed by a registered buildor, <br />Other <br />I have read af~d ~9¢ee to the terms stated on the reverso slde of DATE: ........ <br />~hlS document. <br /> <br />ow~]-E: 09/05/89 TTME: 8:43;28a TAX LOT: CATgGORY: <br /> <br /> BLAYLOCK, VERNON <br />SITUS ADDRESS: CONSTRUCTION TYPE: OCCUPANCY: <br /> <br />9487 STAYTON RO SE GON~RAOTCITY: UGS; <br />AUMSV~ LLE, OR 97:325 <br />USE OF BUILDING: MARION COUNTY NO <br /> <br />OCCU CANT LOAD: <br /> <br /> NO. OF BEDROOMS <br /> <br />/ 9548 STAYTON RD ~E 75g~5~95 ~ <br /> <br /> 24 <br /> <br /> !4_0000 <br /> <br /> SITE NUMSER~ i'! <br /> RANO~/ALUATION: ZO,e <br /> <br />9S iRREG. LOT: 2!/~ CORNER: <br />AC NO NO <br /> <br />MAP: <br /> <br />'evpE: m. EC,RICAL <br /> <br />PERMIT OR APPLICATION NO: 18802 <br /> <br /> SUPERVISING ELECTR I C I A ~i/N .. M8 ?~R <br /> <br /> ITEM <br />C/I SERV 201-'400 AMPS <br />F,_EET SURCHARGE '-ZONE 3 <br />E~.ECTRICAL. STATE SURCHARGE <br /> <br />DUAN T I T¥ AMOUNT <br /> 1 $!00_0¢:; <br /> <br /> $5.0C <br /> <br />TOTAL ASSESSED FEES <br />~REV'JrOUS RECEIPTS <br /> HIS RECEIPT <br /> <br />BALANCE DUE $0.~,," c. <br /> <br />PAYEE: GLIDEWELL FARh,!S INC qECEIPT NO: ~973}~ <br />RECEIVED 8Y: DM 'TYPE: CK CHEC~ <br /> <br />~ THIS IS A VALIO PEEMIT m THIS PERNIT 'EXPIRES ~80.DAYS PEON ITS IS-SUE DATE, IF <br />CONSTRUCTION CEASES FOR A PERIOD OF: 180 DAYS, OR'IF; CONSTRUCTION FAILS TO NEET ALL <br />RE(~dIRE~ENTS OF STATE LAWS AND I~¢.RION' CX]UNTY BUILBING AND ZONING ORDINANCES, ?HiS PERMIT <br /> <br />SHALL BECOME NULL AND VOID.: <br /> <br />RE:?/¢RKS: IRRIGA'fION SERVICE ONLY R~7062 <br /> <br />OONALD E, NOODLEY, MARION COUNTY BUILDING OFFICIAL <br /> <br />OFFICE COPY <br /> <br /> <br />