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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 P.M. - 8;00 A.M. <br /> <br />I am performing work on a property I own or occupy, <br />I am a registered builder OR ) the authorized rerresentative <br />of a reRistered builder. <br />The. work will be performed by a registered builder. <br /> <br />DATE: 02/22~88 TIME: 2:00:08p <br /> <br />OWNER: LULAY, ADRI/r¢4 ~ TAX t-ET: <br /> <br />SITUS ADDRESS: <br /> <br /> 11002 SHAFF RD SE <br /> <br />· 10981 ~AFF RD SE <br /> AU~VZLLE OR 9?325 <br /> ~E: ?69-5388 <br /> <br />iOCCUPANCY: <br />iOCCUPANT LOAO; <br /> <br />SITE NUMBER: 3584 <br />VALUATION: <br /> <br />RESIDENTIAL <br /> <br /> · ZONE' MAP:60 <br />LOT BLOCK: SECTION; 08 ?OWNSHiP: 'gS "RANGE: 1N EfU <br /> <br /> ........ ' COS <br />WIDTH DEPTH AREA: 77.0000 UNITS ~ ; IRREG· LOT: NO ' NYE~ ' <br /> <br /> CONTRACTOR, NO. SUPERVISING ELECTRICIAN/NUMBER <br /> LICENSE NO: <br /> LULAY, ADRIAN <br /> 10981 ~AFF RD SE <br /> AUNSVILLE OR 97325 <br /> PHONE: 769-5388 <br /> <br /> ITEN (~JANTITY <br /> MOBILE HONE SPACE (SVC Eq~JZP) 1 <br /> MOBILE HOME CONNECTION 1 <br /> FLEET ,SURCHARGE -ZONE 4 <br /> ELECTRICAL STATE SURCHARGE <br /> <br /> ~OTAL,ASS~ED FEES <br /> PREVIOUS:,RECEIPTS <br /> THIS RECEIPT <br /> <br /> BA'[JANCE DUE <br /> <br /> PAYEE: RECEIPT NO= <br /> RECEIVED BY: OM ,TYPE: CHECK ~: <br /> <br />AMOUNT <br /> ~20.00 <br /> 20.00 <br /> ~5.12 <br /> 2.00 <br /> <br />~47.12 <br /> 47~12 <br /> $o.oo <br /> <br />$0.00 <br /> <br />:* THI~ I.~ A VALID PERMIT :~ THIS, PERMI~ ID(PI:RB~ ?] 80 ~ F~' I~ I~E ~TE. IF <br />~ffI~ C~ ~ A ~I~ ¢,.'180'.B~,~',~ ~E ~E~ FAI~ TO ~ ALL <br />~I~ OF ~ATE ~ ~O ~I~ ~ ~I~l~ ~D, Z~ ORDi~, ~IS ~IT <br />~ B~ NU~ ~D ~ID_ <br /> <br />REMARKS: SERV & CONN R~ff,888~ <br /> <br />DONALD E. NOODLEY, MARION COUNTY BUILDING OFFICIAL/ .BY <br /> <br />FORM ,, MC l~.!,u ~Ev ,~/~= OFFICE COPY <br /> <br /> <br />