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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 a~.roperty I own or occupy <br />I am a registered builder OH ( ) the authorized representative SIGNATURE OF APPLI <br />of a registered builder. <br />The work will be performed by a registered builder, <br />Other <br />I have read and agree to the terms stated on the reverse side of GATE: <br /> <br />OWNER: <br /> gATE; 06/'29/90 TIME: 16:06:;¢3 <br />SITUS ADDRE~"~URCN OF C~'f~g O~- pROPHECY <br /> <br /> TAX LC~: <br /> <br />CONSfgo~ON TYPE: 61221-000 <br /> <br />CATEGORY: <br /> <br />OCCUPANCY: <br /> <br />COIv~ERCi AL <br /> <br /> , CONTRACT CLTY: UGB; <br />1063'7 STAYTON RD SE <br /> MAR~[,~4 COUN'I'Y NO <br /> <br />MAILING ADDRESS SUBD~VISiON. <br /> <br /> 916 N BIRCH C/O OENNi$ OL.~YON <br /> 8'I'AY'rON, OR. 9?383 <br /> PHONE: 769-5088 <br />LOT: SLOCK' SECT[CHI <br /> <br />TOWNSHIP. <br /> <br />SITE '4U~ER: 2302 <br />RA~J~LUA'r ION: ZONE <br /> <br />MAP: <br /> <br />2. AC NO N,5 <br /> <br />TYPE: ELECTRICAL PERlVlI'T' OR APPLiCATiON NO: <br /> <br />252?2 <br /> <br />OON'rRAC'FOR, NO. 59874 <br />LICENSE NO: <br />GREC, INC <br />P.O. BOX 629 <br />DALLAS, OR 97338 <br />PHONEt 393-4205 <br /> <br />SUPERVISING ELgC'I'RiCIAN/NUI~/gER <br />GREGG MILLER 3308S <br /> <br /> i'I'E~ <br />C/i SERV 201-&go AMP~ <br />FLEE1' ~SURCHAROE -ZONE 3 <br />ELECTRICAL STATE SURCHAf-~iE <br /> <br />QUANTIFY ~v',OUNT <br /> $100.00 <br /> $3.84 <br /> $5.00 <br /> <br /> TOllAL ~ESSED FEES $108.84 <br /> PREVIOJS RECEIPTS $0.00 <br /> THiS RECEIPT $108.84 <br /> <br /> PAYEE: GMEC, tHC <br /> DUE <br /> $0.00 <br /> <br /> RECEIPT NO: 26'759 <br /> RECEIVED BY: DR2 .__.~/__...~..............._ TYPE: CK CHECK ~t 1'794 <br /> <br />* THIS iS A VALID PER~IIT ~ ~IS ~IT ~Pi~ )80 ~ F~ ITS I~E gATE. <br />~T~CTI~ C~ ~R A ~RIOD OF 180 ~ OR IF ~T~CTI~ FAI~ TO MEET ALL <br />~IR~TS OF ~TATE ~ ~D~RI~ ~NTY BUILDING ~D Z~ING ORDIN~C~, THiS PE~iT <br /> <br />RE~ARKS: 400 ,~¢4P ~ERV R~3561 <br /> <br />DONALD E. ~'E20DLEY, ~ARIC,~ COUN'TY BUILDING OFFICIAL/ BY <br /> <br />OFFICE COPY <br /> <br />FORM # MC 15-S6 REV, <br /> <br /> <br />