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MARION COUNT~ BLL~DING INSPECTION <br />SENATOR BLDG. NO. 225 <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 /> i 8rn performing work on 8 property I own or occupy. <br /> I am a registered builder OR the authorized representative <br /> of a registered builder. <br /> The work will be performed by a registered builder, <br /> Other~ <br /> I have read and agree fo the terms stated on the reverse side of <br /> this document. <br /> <br />DATE.* 11,/20/89 TIME: 11.'48:B7 <br />OWNER <br /> CLARK, DAVID <br /> <br />SITUS ADDRESS; <br /> <br />S GNATURE OF APPLICANT; <br /> <br /> 0ATE' <br /> <br /> TAX LOT' <br /> <br /> CONSTRUCTION TYPE. <br /> <br /> 12142 FRY RD NE <br />AURORA OR 97002 <br /> <br /> 2ONTRACT CITY <br /> <br />MARION COUNTY <br /> <br />MAILING ADDRESS: <br /> <br />SUBDIVISION <br /> <br />UGS: <br /> <br /> NO <br /> <br />RESIDENTIAL <br /> <br />~IDTH' ',bE PTH: AREA: LJNIT~ <br /> <br />SITE NUMBER: <br /> VALUATION: <br /> <br /> RANGE <br /> <br /> RREG. LOT. <br /> NO <br /> <br />ZONE: <br /> <br />CORNER: <br /> NO <br /> <br />MAP; <br /> <br />TYPE: ELECTRICAL PERMIT OR APPLICATION NO: <br /> <br />20366 <br /> <br />CONTRACTOR, NO. 6281 <br />LICENSE NO: <br />ENGELMAN ELECTRIC <br />P.O. 8OX 451 <br />HUBbArD, ORFJgON 970~2 <br />PHONE, 981-8041 <br /> <br />~PERVISING ELECTRICIAN/NU~E~ER <br />A~I. ENGELMAN <br /> <br /> ITE~ <br />TNO OR RORE NE~ OTRCUTT$;ALT OR EXT <br />FLEET ~JENAEGE -ZONE 6 <br />ELECTRICAL STATE SURCHARGE <br /> <br />PAYEE= ENSEM~Jq ELECTRIC <br />RECEIVED BY: PR <br /> <br />TOTAL AE~ESSED FEES <br />PREVIOLJS RECEIPTS <br />THIS RECEIPT <br /> <br />BALANCE DUE <br /> <br />TYPE** CK <br /> <br />~UANTITY /~OUNT <br /> 1 $90.00 <br /> ~7.68 <br /> 1.50 <br /> <br /> $39.18 <br />~0.00 <br /> 3g,18 <br /> <br />$0.00 <br /> <br />RECEIPT NO: *598 <br /> CHECK ~= ~995 <br /> <br /> THIS lB A VALID PERI'IT ~ :THIS I:~E~IT EXPIRES 180 DAYS FROf,1 ITS I~E ~TE. IF <br />~~ C~B ~ A ~RI~ 180 ~, OR IF ~I~ FAI~ TO ~ ALL <br /> OF ~ATE ~ ~D~I~ ~ ~ILDI~ ~D ~ING ORDINal. ~IS P~IT <br /> ~LL ~D ~ID. · <br /> R~R~: 2~IR ~6589 ~~ <br /> <br />OFFICE COPY <br /> <br /> <br />