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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PRONE 588-5147 <br /> CODE-A-PHONE 4:30 P,M. - 8:00 A;M. <br /> <br />of a regi~;tered builder, <br /> <br />O~: 10/05/87 TIME: 8:37'.92a <br /> <br /> SI LBERGNAGEL, RON <br />SITUS ADDRESS~ CONSTRUCTION TYP~: ; OCCUPANCY: <br /> <br />COMMER~C,AL <br /> <br />9162 N STAYTON RD SE i CONTRACT CITY; I UGB'. i OCCUPANT LOAO: <br />AUIvkSV I LLE OR 97325 ! ~ I <br />USE OF BUILDING: F4AR'I'ON-'COUNTY NO iNo Or 8EDaOOMS <br /> <br /> SAME <br /> <br /> PRONE: ?49-2826 <br /> <br />LOT: BLOCK: <br /> <br /> i SITE NUMBER: I2716 <br /> i , VALUATION: <br /> SECT;ON; ]TOWNSHIP: i RANGE; i ZONE: MAP: <br /> <br />~AREA: iUNITS; ;1~5~8. L6~:2N iCO.N~.: <br /> , j <br /> : NC NO <br /> <br />TYPE: ELECTRICAL <br /> <br />CONTRACTOR, NO. 3964 <br />LICENSE NO; <br />JACK'S ELECTRIC <br />10764 N~LL CREEK RD <br />AU~SVILLE 9?325 <br />PHONE: 749-2971 <br /> <br />PERMIT OR APPLICATION NO: 4??0 <br /> <br /> ~¢JPEI~N'ISING ELECTRICIAN/NUMBER <br /> JOHN A. SREER/1099S <br /> <br /> ITEM <br />SER¥ CHANGE ONLY-EXISTING RESIDENCE <br />FLEET SURCHARGE -ZON~ ~ <br />ELECTRICAL STATE SURCHARGE <br /> <br />PAYEE: JACK'S ELECTRIC <br /> <br />QUANTITY AMOUNT <br /> $20,00 <br /> $3,84 <br /> $1,00 <br /> <br />:*TOTAL ~A'~ED:'~EES <br /> PRE¥'I OLIS: REC~;PTS <br /> <br /> ~ ," RECEIPT NO'- <br /> <br />$24.84 <br /> $0.00 <br />$24.84 <br /> <br />$0,00 <br /> <br />532? <br /> <br /> RECEIVED BY: c] <br />...................... =:===::~-~,~E..~; ---~--" '~ .... :~BE.': CK CHECK ~: 3610 <br /> <br /> C~ ~R A P~IODOF']80' ~;, ~ IF::~BCTI$ FAi~ TO ~T ~L <br /> REdIReCTS OF STATE~ID :~.~D ~Oi~. ~IS P~IT <br /> ~L BE~ NULL ~D " ':' ', :" <br /> <br /> 0ONALD E. NOODLEY, MARION COUNTY BUILDING OFFICIAL / BY <br /> <br />,O*M ,, MC ~-~ ~ev e/a~ OFFICE COPY <br /> <br /> <br />