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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 />COD~TA-PH:,~NE 4:30 P,M. - 8:O0 A.M, <br /> <br />I am performing work on a property I own or occupy. <br />lamaregisteredbullderOR( )the,Authorized representative <br />of a re~isteted builder, <br />The work will be performed by a registered builder, <br />Other <br /> <br /> DATE: 11/09/89 TIME: <br />OWNER; <br /> NALLSTROM, GARY <br />SITUS ADDRESSz <br /> <br /> 8?49 DARLEY RD SE CONTRA~ClTY'. : UGB: <br /> AuMSVI LLE OR 97325 i i <br /> MARI ON..COUNTY : NO <br />USE OF BUILDING; <br /> <br />MAILING ADDRESS: w~ SUBDIVISION; <br /> <br /> SAME <br /> <br /> PHONE: 743-2131 <br /> <br />LOT: BLOCK: <br /> <br />764 <br /> <br /> SITE NUMBER: 8302 <br /> VALUATIONs <br /> SECTION; TOWNSMIPZ RANGE: <br /> <br />: 13 9S 2W EFU <br />' AREA: 0~ITS: IRREG. LOT: CORNERI <br /> <br /> NO <br /> <br />: CATEGORY: <br /> RESIDENTIAL; <br />OCCUPANCY; <br /> <br />OCCUPANT LOA~): <br /> <br />MAP: <br /> <br /> 62 <br /> <br />TYPE: ELECTRICAL <br /> <br />CONTRACTOR, NO. 2075 <br />LICENSE NO: <br />NORTHSIDE ELECTRIC INC <br />PO BOX 7124 <br />SALF-M, OREGON 9?303 <br />PHONE: 393-5559 <br /> <br />PER~'IlT OR APPLICATION NO: 20161 <br /> <br /> SUPERVISING ELECTRICiAN/NUMBER <br /> ARLIN E. ADAJ'cE¢:~ /1479S <br /> <br /> ITEJ~I <br />3'!40 OR MORE NEW CIRCUITS;ALT OR EXT <br />FLEET SURCHARGE -ZONE 3 <br />ELECTRICAL STATE SURCHARGE <br /> <br />PAYEE; NORTHSIDE ELECTRIC INC <br /> <br />QUANTITY AI~SUNT <br /> 1 $30.00 <br /> $3.84 <br /> $1.50 <br /> <br /> TOTALASSESSED FEEs <br /> PREVZOUS RECEIPTS <br />THIS RECEIPT <br /> <br />BALANCE DUE <br /> <br />RECEIPT NO: <br /> <br />$35.34 <br /> $0.00 <br />$35.34 <br /> <br /> $0.00 <br />21399 <br /> <br />RECEIVED BY; PB TYPE: CK CHECK ~; ??72 <br />* THIS IS A VALID PERI, IT*: TH~8 PERNIT EX~IRES 180 DAYS FRON ItS ISSUE DATE. If <br />CONSTRUCTION CEASES FOR A PERIOD OF :180 DAYS, OR IF CON8TRUCTZON FAILS TO MEET ALL <br />REQUIRBV~ENTS OF STATE LAWS ANDMARION:COUNTYBUILDINGANDZONING ORDINANCES, THIS PEI~IlT <br />SHALL BECOME NULL AND VOID; <br /> <br />REMARKS: 2 CIR R~6263 <br />DONALD E. NOODLEY, ~RZON COUNT~ BUILDING OFF~CZAL /~¢ ~-- /'~ <br /> <br />FOnM" MS '~ :~h ~V ~ OFFICE COPY <br /> <br /> <br />