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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 5~8-5147 <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 am a regls~eced builder OR ~he authorized reprosen~atlve <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 <br />this document. <br /> <br />SIGNATURE OF APPUCANT: <br /> <br /> DATE: <br /> <br />{~qi 02/02/90 TINE: 14:03:22 <br />SITUS AD~{S.~TER, RALPH <br /> <br />fax LOT: <br /> <br />CONSTRUCTION 'fYPEz <br /> <br />CATEGONY: <br /> <br />OCCUr*ANCY: RES I DENT I AL <br /> <br />880 9TH ST <br /> <br />OR. 97325 <br /> <br /> CONTRACT CITY: CGB: <br /> <br />AUMSVILLE NO <br /> SU BDiVISION~ <br /> <br />OCCUPANT t. OAO: <br /> <br />PO BOX 12533 <br />SALEN OR 97309 <br />PHONE; 588-2373 <br />LOT: gLOCK: <br /> <br />SECTION: <br /> <br /> DELMAR ~8 <br /> <br />SITE NUMBER: 8688 <br />V,A,L~IATION: ZONE; <br /> <br />MAP: <br /> <br />W~OT~ OEPTH:5 AREA: <br /> <br />24 :UNITS: 88 IRREG. L O~,~ CORNER: <br /> <br />51 <br /> <br />TYPE: ELECTRICAL PEI;~IIT OR APPLICATION NO: <br /> <br />21723 <br /> <br />CONTRACTOR, NO. 2075 <br />LICE~4SE NO: <br />NORTHSIDE ELECTRIC INC <br />PO BOX 7124 <br />SALEN, OREGON 97303 <br />PHONE: 393-5559 <br /> <br />SUPERVISING ELECTRICIAN/NUNBER <br />ARLIN E. A~ /14796 <br /> <br /> IT <br /> <br />ELECTRICAL STATE SURCHARGE <br /> <br />QUANTITY ANOUNT <br /> I $75.00 <br /> $3.84 <br /> $3.75 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$82.59 <br /> $o.oo <br />$82.59 <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE: NORTHSIDE ELECTRIC INC RECEIPT NO: 23032 <br />RECEIVED BY: Biff TYPE: CK CHECK ~: 8016 <br />* THIS IS A VALID PERi'liT * THIS PEI~IT EXPIRES 180 DAYS FROM IT"& ISSUE DATE. IF <br /> <br />RENARKS: RES RAt2664 <br /> <br />DONALD E. ~OODLEY, NARION COUNTY BUILDING OFFICIAL / BY <br /> <br />REV 6/~'r OF¢ICE COPY <br /> <br /> <br />