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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 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />Other <br /> <br />r have read end a0ree to the terms stated on the reverse side of <br /> <br /> TA× LOT; <br /> <br /> ~R~, A C <br />SITUS ADDRESS: <br /> CONSTRUCtIoN TYPE: <br /> <br />CATEGORY: <br /> <br />OCCUPANCY: <br /> <br />RES±DENIIAL, <br /> <br /> 34:~97 KEIL RD NE , CONTRACT CITY: j tJ~B[ <br /> AURORA OR 9?002 ' <br /> <br />USE OF eU~LO~N~: f4ARiON, COtJNI:¥ . i NO <br /> <br />MAILING ADDRESS: .... suBDIvIsIONI <br /> <br />10'190 ~ VIEW TERRACE <br />'f~GARD, OR 97224 <br />PH{~E: 539-?934 <br /> <br />11 <br /> <br /> SITE NLI¢4~ ER.- 8;304 <br /> VALUATION: <br />?OWNSH P RA'~ ~i ! ~ONE; MAP: <br /> <br /> IRREG. LOT: CORNER: <br /> AC NO : NO <br /> <br />TYPE; ELECTRICAL PERMIT OR APPLiCATiON NO: <br /> <br />~5000 <br /> <br />CON T P, AC'f OR, NO. <br />L .( C E;N,SE NO: <br />SEARS, A C <br />10190 SW VJ,~W TERRACE <br />f'iGAR0, OR 9?224 <br />PH(])N~: 539-?934 <br /> <br />SLIpERVi~iNG ELEC'FRICIAN/NUNBER <br /> <br /> if'Elvl <br />SERViCE/FEEDER 101 TO 400 AJvl~5 <br />ELECTRICAL 5'fA'I'E SURCHARGE <br /> <br />QUAN TI TY AMOUN I <br /> $50,0O <br /> <br />TO'rAL AE~ED FEES <br />PREVICU~ RECEIPTS <br />THIS RECEi~'f' <br /> <br />$63.00 <br /> <br />$53.00 <br /> <br />BALANCE DUE $0_00 <br /> <br /> PAYEE: SEARS, A C RECEIPT NO; 35898 <br /> RECEIVED BY: PB TYPE; CK CHECK ~: 2585 <br /> <br />* iHIB IS A VALID PE~IlT ~ THi~ PE~IT EXPIRE~51801~AYSFRO~l ITS IEN-~JE DAI'E. iF <br />~ST~C'fl~ C~ ~R A PERIOD OF 180 ~, OR IF ~ST~CTI~ FAi~ TO ~EET ALL <br />~IR~TS OF S~ATE ~RI~ ~NTY BUI~IN~ ~0 Z~iNG OROIN~C~, THiS <br />~ALL ~E NULL ~0 ~10. <br /> <br />REMARKS: 200 AMP FOR srG BLr,)G R~2585 <br /> <br /> ~OOOLE:Y, MARION COUN'IY 8UiLO~NG OFFiCiAL / BY ................... ~ <br />[~NALD <br /> E, <br /> <br />FORM/~ MC 15-66 REV. 4PJO OFFICE COPY <br /> <br /> <br />