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MARION COUNTY BUILDING INSPECTION <br />SENATOR SLDG, 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 />~ am performln9 work on a property I own or occupy. <br />I 8m a registered builder OR the au horized rep esen a ye <br /> of a registered builder. <br />The work will be performed by a registered builder. <br />Other__ <br />~ have read and agree to the terms sta~ed on the reverse side <br />this document, <br /> <br />SlTUSAOBRE~CKER~ TOM& SHIRLEY CONSTRUCTION'KY~: ¢OCCUP,ANCY; RESIDENTIAL <br /> <br /> ~"b6~'/~.8~ ~t~¥: i OCCUPANT <br /> 12444 N. STAYT~ RD SE ~ , <br />AU~V~LLE OR. 9~25 , <br />USE OF BUILDING: ~I~ ~NTY NO ;,0 <br /> <br />MAILING ADDRESS: <br /> <br /> SA~E <br /> <br /> PHONE: ?69-3304 <br />LOT: BLOCK: <br /> <br />WIDTH: ~PTH. <br /> <br /> ', SITE NUMBER.* 8409 <br />;SECTION; 'ro~v~§~l~i hA);('q¢~C,I,;i'AT[ON'-'' I :7ONE: i MAP <br /> <br />TYPE: ELECTRICAL <br /> <br />CONTRACTOR. NO. 40298 <br />LICENSE NO: <br />GRISC,~OLB ELECTRIC <br />22856 JENNIE RD <br />LYONS. OREGON 9?358 <br />PHONE: 859-2214 <br /> <br />PERMIT OR APPLICATION NO: 20293 <br /> <br /> SUPERVISING ELECTRICIAN/NUMBER <br /> MARK S GRISAE)LD <br /> <br /> ITEN <br />SERV CHANGE ONLY-EXISTING RESIDENCE <br />TWO OR MORE NEN CIRCUITS;ALT OR E:XT <br />FLEET SURCHARGE -ZONE 3 <br />ELECTRICAL STATE SURCHARGE <br /> <br />PAYEE: GRISNOLO ELECTRIC <br /> <br />QUANTITY AMOUNT <br />1 $30.00 <br />1 $30.00 <br /> $3.84 <br /> $3.0o <br /> <br />TOTAL AS.SE:~::x'SED FEES <br />PREVIQUS RECEIPTS <br />THIS RECEIPT <br /> <br />$66.84 <br /> $o.oo <br />$66.84 <br /> <br />BALANCE BUR $0+ 0O <br /> <br />RECEIPT NO: <br /> <br /> 21528 <br />RECEIVED BY~ pr ........ ~,,, ___ TYPE: CK CHECK ~= 200 <br />* THIS I$ A VALID PEI;~IlT ~ THISPERMIT EXPIRES 180DAYS FROM iTS ISSUE DATE. IF <br />CONSTRUCTION ~FE~TE~ FOR A PERIOD OF 180 DAYS; OR IF CCt~E~RUCTION FAILS TO MEET ALL <br />REQUIREMENTS $ ATE L~ AND MARION COUNTY BUILDING AND ZONING ORDINANCES, THIS PERMIT <br />SHALL BECOME NULL AND VOID. <br /> <br />REMARKS: SERV CHG & 2+CIR R~6577 <br /> <br />OONAL0 E. WOODLEY, ~ARION COUNTY BUILDING OFFICIAL / BY <br /> <br />FORM" MB I~, ',f; tlFV ¢/87 OFFICE COPY <br /> <br /> <br />