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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 property I own or occupy. <br />lam aregistered builder OR( ) the authorized representative <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 <br />this document. <br /> <br />SIGNATURE OF APPLICANT: <br /> DATEz <br /> <br />OWN~ATE: 05/29/91 <br />sn'us AgORESSJOHNSON ' <br /> <br />TAX LOT: <br /> <br /> ?3350-080-8? <br />~Ns¢~UC+ION TYPE: <br /> <br /> ~oN~RACT CITY'. <br />1§872 OL,f'fS'T'EAO RD <br />AURORA OR 9'?002: <br />USE OF BUILDING: ~'~RIr-.~ COUNTY <br /> <br />NO <br /> <br />MAILING ADDRESS .... SUBDIVISION <br /> <br />CATEGORY: <br /> <br /> RES i DEN l ~ AL <br />OCCUPANCY: <br /> <br /> 5.AME <br /> DAY 582:-2420 <br /> PHON~:: 678-5133 SITE NUf4BER: 530 <br /> . VALUA'f ION: <br />LO]' BLOCK SSDTION: TOWNSHIP RANGE' ;:ONE. <br /> <br />WOTN' DEPTH: AREA: 'l~ UNITS; ~S ' RREG LOT 1W CORNER: EF'U <br /> 0.42 AC NO NO <br /> <br />MAP: <br /> <br />TYPE: ELEC'f'RiCAL <br /> <br />C¢~f'RACFOR, NO. <br />LICENSE NO: <br />RICHES ELEC]RiC <br />395 IV~ARKE'f' SI' NE <br />SALEM OR 97301 <br />PHONE: 362~4~56 <br /> <br /> PERMIT OR APPLiCATiON NO: 32533 <br /> <br />4259 ~UP~RViSiNG ELEC'fIRICiAN/NU~BER <br /> CLAUDE NUNEIV[ACHER 24~26C <br /> <br /> i'f'F-.J'4 <br />BRANCH CiRCUiTS - 'fWD TO TEN <br />ELECTRICAL STATE SURCHARGE <br /> <br />PAYEE: RiCHES ELECTRIC <br />RECE{VE0 BY: PR <br /> <br />QUANTITY AIgOUNT <br /> 1 $50.00 <br /> $2.50 <br /> <br />TOTAL A~,.~%~ED FEE8 <br />PRE¥1OUS RECEIPTS <br />'f'Hl5 RECEIPT <br /> <br />$5~,50 <br /> $o,oo <br /> <br />BALANCE: DUE $0.00 <br /> <br />R~CEi PT NO: 34327 <br />TYPE; CK CHECK ;~: 3620 <br /> <br />~ THI~ iS A VALID PERI,liT · THIS PER/~IiT E~PIR~ 18B DAY~ FRC~4 ITS I~,~UE DATE. iF <br />~ONSTRUCTION C~A,~ ~OR A PERIOD DP 180 OAY~, OR IP CONSTRUCTION PAIL~ TO flEET ALL <br />REQUiREmENTS DP STATE I./M~'AND MARION COUNTY BUILDING ANO ZONING ORDINANCES, THIS PER~IT <br />~SHALL BECO~I~ NULL AND VOID. <br /> <br />REMARKS: 2- 10 ClR RAt6821 <br /> <br />OONALD E. WOODLEY, [~ARiON COUNTY BUILDING OFFICIAL / BY <br /> <br /> OFFICE COPY <br />FORM # MD 15-5e REV, <br /> <br /> <br />