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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 228 <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 />~ am performing work on a groporty I own or o~cugy. <br />I am ~ r~gistered" builder OR the authorized representative SIGNATURE OF APPI,ICANT: <br />of a registered builder. <br />The work will be performed by a registered builder. <br />Other <br />I have read and agree to the terms stated on the reverse side of DATE'. <br /> <br />cJ;;M~E: 11/28/89 TIME: 14=16:20 TAX LOT: CATEGORY: <br /> <br /> HUBER, ARf4IN R. <br />SITUS ADDRESS; CONSTRUCTION TYPE: OCCUPANCY: <br /> <br /> CO NTRACl CITY: UGh: <br /> 880 MAIN ST -- <br /> AUF,1SVILLE OR 97225 <br /> 4/JHSVILLE NO <br />USE OF BUILDING: <br /> <br />SUBDIVISION: <br /> <br /> RESIDENTIAL <br /> <br />OCCUPANT LOAD: <br /> <br />SAME <br /> <br />PHONE: <br /> <br />WIDTH~ <br /> <br />BLOCK: SECTIONI TOWNSHIP; <br />DEPTH: AREA: UNITS: <br /> <br />SITE NUMBER: 8779 <br />VALUATION: <br /> <br />IRREG, LOT: CORNER: <br /> NO NO <br /> <br />MAP: <br /> <br />TYPE: ELECTRICAL PERMIT OR APPLICATION NO: <br /> <br />20491 <br /> <br />CONTRACTOR. NO. 48560 <br />LICENSE NO: <br />SPARKY ELECTRIC CO. <br />?53? LAKESIDE DRIVE NE <br />SALEM, OR 97305 <br />PHONE: 393-2604 <br /> <br />.SUPERVISING ELECTRICIAN/NUMBER <br />DUANE VAUSEL ~25403 <br /> <br /> ITF~ <br />SERV CHANGE ONLY-EXISTING RESIDENCE <br />FLEET SURCHARGE -ZONE 3 <br />ELECTRICAL STATE SURCHARGE <br /> <br />QUANTITY AMOUNT <br /> 1 $30.00 <br /> $8.84 <br /> 1.50 <br /> <br />TOTAL A,.S~ED FEES <br />PRE¥IC~JS RECEIPTS <br />THIS RECEIPT <br /> <br /> $0.00 <br />$35.34 <br /> <br />BALANCE DUE $0.00 <br /> <br /> PAYEE: SPARKY ELECTRIC CO. RECEI PT NO: 21 ?45 <br /> RECEIVED BY: PS TYPE: CK CHECK ~: ~01g <br /> <br /> * THIS I$ A VALID PEI~IIT * ~IS PE~IT ~PIRB 180 ~ F~ ITS I~E DATE. IF <br />~STBOTI~ OBB BRA DERIOD OF 180 ~, OR IF ~BOTI~ FAIB TO ME~ ALL <br />~RBBTS OF STATE ~ ~D ~RI~ ~N~ 8UILDIN6 ~D Z~IN80RDiN~C~, ~I~ PEBIT <br /> L 8i~f NULL 8D ~ID. <br /> <br />RE, lARKS: GERV/CHG R~t6323 <br /> <br />DONALD E. NOODLEY, MARION COUNTY BUILDING OFFICIAL / BY <br /> <br />FC.DRM i/ M{: 12 !W, REV 0/8'¢ OFFICE COPY <br /> <br /> <br />