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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG NO, 225 <br />220 HiGH STREF'T NE <br /> SALEM1 OREGON 97301 <br /> <br /> PHONE 588-5147 <br /> CODE-A-PHONE 4:30 P,M. - 8:00 A.M, <br /> <br />t ar~ performing work on . property , Owrl or Occupy. SIGNATURE OF APPLICANT; ~-.~:. <br />I am a registered builder OR { the authorized represer~tative <br /> <br />o,~h~T~.+ 07/13/88 TIME: <br /> L~NDLEY, ~AYNE ~ 03019-000 ~ RESZDENT]AL.. <br /> <br /> 5912 V~L~GE VIE~ CT SE SE <br /> AUMSVI LLE OR 97325 ~ ~ . <br /> ~-~%~..--:,L--.--NO <br /> <br />PHONE: <br />I. OT: BLOCK; <br /> <br />14 <br /> <br />TYPEt ELECTRICAL <br /> <br /> SITE NUfVSER: 4896 <br /> VALUATION: <br /> i~6~ib'N: i~6~$~i~i ............. T'~%E~ ........................... ~8~ ......................... ~'¢: <br /> <br /> ~.8 ......... ~ ............ ~ ........ ............. AR3 48 <br /> <br /> ' oo9oi No NO <br /> <br />PERMIT OR APPLICATION NO; 900969? <br /> <br />CONTRACTOR, NO. 38238 <br />LICENSE NO: <br />SANTIAM VALLEY HOMES <br />11373 MILLCREEK RD SE <br />AUMSVILLE OR 97~25 <br />PHONE~ <br /> <br />SUPERVISING ELECTRICIAN/NUNBER <br /> <br /> ITEN <br />IV~ILE HO~E CONNECTION <br />FLEET SURCHARGE -ZONE 3 <br />ELECTRICAL STATE SURCHARGE <br /> <br />PAYEE, SANTIAM VALLEY HOMES <br /> <br />~ THIS IS NOT A PERMIT. THIS: <br />FOLLOWING ~.JST BE COMPLETED.' ITl, <br />ALL NECE~RY INFORMATION: ,HAS BEEN <br /> <br /> QUANTI/Y .a~4OUNT <br /> 1 $20.00 <br /> $3_84 <br /> $1.00 <br /> <br />TOTAE.::;ASSES~ED:.:.FEES $24.84 <br /> $0.00 <br />THIS. RECEIPT::' $24_84 <br /> <br />RECEIPT NO: 10375 <br />CHECK ~ 8861 <br /> <br />P~3CE;S.S I~ERE THE <br />THE APPLICANT TO ASSURE THAT <br /> i / <br /> <br />PLAN REVIEW: BY DATE ~,___~_ <br /> <br />BY <br /> <br />DATE <br /> <br />~O.M * MC ~5.~ .~v ~/.7 OFFICE COPY <br /> <br /> <br />