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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> '~ PH(~E 588-5147 <br /> CODE-A-PHONE 4;30 P.M, - 8:00 A.M. <br /> <br />I am performing work on 8property I own or occupy. <br /> <br />SIGNATURE OF APPLICANT: <br /> <br /> DATE: <br /> <br />o3/o8/eo <br /> <br /> TOM <br /> <br />TIME: 13:51:44 <br /> <br />TAX LOT: <br /> 90040-040 <br />CON$¥RUCTION TYPE: <br /> <br />CATEGORY: <br /> <br />OCCUPANCY: <br /> <br />RESI DENTIAE", ~ <br /> <br /> 905 9TH ST <br />AUMSVILLE <br /> <br />OR 97325 <br /> <br /> CONTRACT ClT~; UGB: <br /> <br />AUMSVILLE NO <br /> <br />OCCUPANTLOAD: <br /> <br /> NO. OFBEDR©OMS: <br /> <br />PO BOX 185 <br />SUBLIMITY OR 9?385 <br />PHONE: ?69-?364 <br /> <br />SITE NUMBER: <br /> VALUAT ION: <br /> <br />MAP: <br /> <br />WIDTH: DEPTH: AREA; <br /> 74 107 <br /> <br />2~ UNITS: 8S IRREG. LOT'. 2~ CORNER; RI <br /> S1= YES NO <br /> <br />51 <br /> <br />TYPE: ELECTRICAL <br /> <br />CONTRACTOR: NO. 20?5 <br />LICENSE NO, <br />NO~rHSIDE ELECTRIC INC <br />PO BOX 7124 <br />SALEM, OREGON 97303 <br />~E: 393-5559 <br /> <br />PEI~tIT OR APPLICATION NO= 22346 <br /> <br /> .E~IPERVISING ELECTRICIAN/NUMBER <br /> ARLIN E, ADAMSON /1479S <br /> <br /> ITE~I <br />RES WIRING < 2000 SO Fi' <br />FLEET SURCHARGE -ZONE 3 <br />ELECTRICAL STATE ,gJRCHARGE: <br /> <br />PAY:EE:NORTH$IDE <br />RECEIVED BY: CL <br /> <br />~ 'i'His IS A VALID I:~I~IIT <br />OON~ffR~TI~ CEASE~ FOR A <br />I~QUI <br /> IRB~8~TS OF STATE <br />~HALL BECI~E NULL AND <br /> <br />QUANTITY ~UNT <br /> I $75.00 <br /> ~S.84 <br /> 3.75 <br /> <br />TOTAL A~SF.~ED; FEES <br />PRE"VI,(~US RECEIPTS <br />THIS RECEIPT <br /> <br />BALaC, ICE "I3,JE: <br /> <br />$82.59 <br /> $o.oo <br />$82+59 <br /> <br />$0.00 <br /> <br />23696 <br /> 8092 <br /> <br />ITJ~ I~SSUE DATE. IF <br /> FAIL..~ TO ~ ALL <br /> OI~IN.~CE~, l~lIS <br /> <br />RB~RK~: RES <br />DONALD E. HOODLEY, MARION C¢3Ut~TY 8U[¢LDING OFFICIAL /,BY ...... .,2 .................. <br /> <br />FO~M ¢ MC ~*.~0 ney, l~/s8 OFFICE COPY <br /> <br /> <br />