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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 22,5 <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 />t am performing work on aproperty ~ own or occupy. <br />l am a registered builder OR ( )theauthodzedrepresenta~ive <br />of a registered builder. <br />The work wilr bo performed by a registered builder. <br />Other_ <br /> <br /> I have read and agree to the term8 8tBted on the reverse side of <br /> <br />:TWT'E: ~q2/09/,~l~' Ti~E: <br /> <br /> 2;K; NNER. CAV~© <br /> <br /> ] 095Ri ~AT']"H,~ ELi LANE <br />AU~?O¢,¥~ OR <br /> <br />USE OF BUILDING: <br /> <br />MAICING ADDRESS: <br /> <br />SAME <br /> <br />;)HE]NE :. <br /> <br />WIDTH <br /> <br />578 <br /> <br /> BLODK <br /> <br />DEPTH: <br /> <br />TYPE: E'I,.~.., ,%~¢,,'.',~,,~ <br /> <br />.... JN R,~.(.. (.,R, NO- <br /> <br />3:32:]4. p <br /> <br /> NE ' <br /> <br /> ~RION C~NTY NO <br /> <br /> i SITE NUMBER: ? 3433 ,,/ <br /> i VALUAT.]ON: 'L_ -- .~,...~/ <br /> <br /> e 4S ~ iN E~'~U <br /> <br />PERM[T OR APPLICATION NO: ~ 6652 ~ <br /> SUPERVISZN3 ELEOTR IC;AN/NUN~BER <br /> <br />LICENSE <br />/t'A ¢,M H AI¥] ELECTRIC <br />1050 LAFAYETTE AVE <br />YE. MINN\,'~LLE, OR 97128 <br />PHC)N E: 4 ? 2 ,,.2 '[ S <br /> <br />WALLY WOOD <br /> <br />C/; SERV TO 10C A~PS <br />;:,,ER";" SURCHARGE -ZONE 8 <br />E:_ECTR:C&I,,, ST.ATE SURCHARGE <br /> <br />PAYEE: F ARNHAM F,..LECTRI C CO, : : ~ECEi PT NC: <br />f~EECEI'¥EX) ~iY: JEI .............. __... ........... .__ :~YpE, i CK CHECK ~:; <br /> <br />~.9'75 <br /> <br />· ~' T~Z,~ Im A VALID PERtClIT m ,~]qIS PERMIT:, EY, PIRES,::180, DAYS FRON: ITS I~E DATE <br />C~¢~CTI~ CE~ES FOR A: PERIOD OF 180 :~S~:~;OR::~F',::::~ST~CT[~ FAI~ TO HE~ ALL <br />~E~IR~TS OF STATE ~ ~D ~RI~ ~N~-- - ~'" BDI~LD~NG ~D'Z~ING ORDIN~CES, ~IS PE~IT <br />~ALL BEdE NULL ~D ~ID. ,':,:: <br /> <br />REN~ARKS: ,00 .~ RgS971 FARNHA~ E:L~ <br /> <br />'~:>~M. ~¢c ,~.56 RSv ~¢.~ OFFICE COPY <br /> <br /> <br />