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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 8m ~ registered builder OR ( ) the authorized representative <br /> of a registered builder, <br /> Tho work will be performed by a registered builder, <br /> Other ............ <br /> I have read arid 8gree fo the terms stated on the reverse side of <br /> th,S documenh <br /> 0ATE: 03,/25/88 TIME: 3:59:40p <br />OWNEn: SCHMIDT, MELVIN <br /> <br />SITUS ADDRESS; <br /> <br /> 19917 GRIM RD <br /> AURORA <br /> <br />MAILING ADDRESS: <br /> <br /> SANE <br /> <br /> PHONE: <br /> <br />LOt: ' BLOCK; <br />WIDTH: SEPTH: <br /> <br />TYPE; ELECTRICAL <br /> <br />CONTRACTOR, NO. 6281 <br />LICENSE NO: <br />ENGELNAN ELECTRIC <br />P.O. BOX 451 <br />HUBBARD, ORE~N 97032 <br />PHONE: 981-8041 <br /> <br /> : TAX LOT: CATEGORY: RESIDENTIAL <br /> <br /> i CONSTRgCTION TYPE: OCrUPANDY: <br /> <br /> NE l ~' ~G'~: OCCUPANT lOAD: <br />OR 97002 i CONTRACT CITY'. <br /> ~RION COUNTY i <br /> N0 0F BEOROOMS <br /> <br /> SITE NUMBER: <br /> VALUAT ION: <br /> <br /> : SECTIEN; 1¥6~$~';1=i ~ R'A~ : MAp; <br /> 4S 1W ~ EFU 5 <br /> A~E~; ~UNITS; ,~ I*REG, LOT: NO <br /> <br />PE~IT OR APPLICATI~ NO: <br /> ~PE~ISING ~LECTRICiAN/NU~ER <br /> ~. ~GE~ <br /> <br /> ITEM <br />C/I SERA/ 101-200 ANI:>S <br />FLEET SURCHARGE -ZONE 6 <br />ELECTRICAL STATE SURCHARGE <br /> <br /> QUANTIIW ANOUNT <br /> 1 $50.00 <br /> $7.88 <br /> $2.50 <br />,]TOTAL'A,SS~EDFEES $60.18 <br />'PRE~F:IOUSRErEI:PTS $0.00 <br />THIS RECEIPT $60.18 <br />i,':8 L_ CE $0.80 <br /> <br />PAYEE: ENGELMAN ELECTRIC ' . ,:RECEIPT NO: 8133 <br />RECEIVED BY: JB , r ,TYPE,!' CK CHECK ~: 9197 <br /> <br />* THIS IS A VALID PEr'lIT ' ~I$: <br />~CTI~ C~ ~R A ~,'~ ~¢'"'"'" FAI~ TO ME~ ALL <br />RE~IR~ OF STATE ~ ~D ~N~ BUILDING::;]]~D ~ING ORDIN~C~, ~IS P~T <br />~L 8~E NULL ~D ~ID.. ' ~: : <br /> <br />R~RKS: 200 ~P ~949~ ~GEL~ ELEC <br /> <br />DONALD E. ~ODLEY, MARI~ COUNTY BUILDING OFFICIAL ~ ~Y <br /> <br />,o*- ,, MC ~5-5~ R~V.~* OFFICE COPY <br /> <br /> <br />