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SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br />SALEM, OREGON 97301 <br /> <br /> PHONE 888-5147 <br /> CODE-A-PHONE 4:30 P.M. - 8:00 A.M. <br /> <br />I am performing work or~ a property I own or croupy, <br />I am a registered builder OR the authorized representative SIGNATURE O¢ APPLICANT: <br /> of a registered builder, <br />The work will be perfort~ed by 8 registered builder. <br />Other <br />I have read 8nd agree to the {erms stated on the reverse side of DATE: <br />this document. <br /> <br />5)ATE: 02/10/88 TIME; 1'!;22;36.a ',YA×LSTi <br />OWNER: , <br /> <br />SITUS ADDRESS: i CONSTrUCtION TYPE: <br /> <br />CATEGORY <br /> <br />290 ~LcVELAND , CONTRACT CITYz i UGB: ;OCCUPANT LOAD: <br /> A~SWILLE J NO <br /> <br />3322 BL~,,. r. <br /> <br />::'HONE: 364"5655 <br /> <br />LOI: 8LOCK: <br /> <br /> :gEPTHI <br /> <br /> ~ O0 50 <br /> <br /> MERRI P'I ELD ADON <br /> <br />5 8S ~ 2 : " <br />SO00. O0 SF ~ NO ; Y~S <br /> <br />TYPE: ELECTRICAL <br /> <br />CONTRACTOR, NO. 3258 <br />L !C£,%'SE NO: <br />JOHNSOhl, 8EN'FLEY ~. <br />345? PECK AVE <br />SALE~ <br />PHONE:: :370--88 i4 <br /> <br />PERMI]' OR APPLICATION NO~ 6668 <br /> <br /> ~UPERV..~N(a ~E.,R~C~AN/NL~BER <br /> <br /> ; TEM <br />-FEMP CONSTR SERV;CE <br />!'~t..¢..',"_1,~'7 SURCHARGE -ZONE 3 <br />E'__E%TR]CAL STAT~ SURCHARGE <br /> <br />PREViOUSRECEIPTS <br /> <br />QUAN, ~ ~ Y .AMOUN 'c <br /> <br />$0 ""' <br /> <br /> : ::;: BALANCE DUE SO .... '"¢ <br /> <br />PAYEE: .JC~N~ON, BENTLEY B. RECE;PT N,~; <br />RECEIVED BY: pb .......... ~ .... ~ .............. ~PE: CK CHECK f~: <br /> <br />C~STRUCTI~ C~ES FOR A PERIOD OF 180 ~%, 'OR:rF::;~ST~CTI~ FAI~ TO MB~ ALL <br />~E~IR~TS OF STATE ~ ~D ~RI~ ~N~ BUILDING ~D Z~:ING ORDIN~CES, ~IS PE~I~ <br />~ALL. BEdE NULL ~B ~ID. ~ : <br /> <br />REMARKS: R~3985 <br /> <br />;3ONALO E. ~OOOL, EY, <br /> <br />MARION COUN*-Y aU,]LOINS C~ZCtAL X'8¥_ .......................... <br /> <br />FO~M '* Mit lb'58 R~V ~ OFFICE COPY <br /> <br /> <br />