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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 />CODE-A-PHONE 4'30 PM - 8 00 A M <br /> <br />I am performing work on a property I own or occupy <br /> <br />I have read and agree to the terms stated on the reverse aide of <br />th~s document <br /> <br /> 08/04/89 TIME: <br /> <br />S~TUS ,oca6ssBERN ING, 8RETT <br /> <br />TAX LOT C~TEGOR¥ <br />RESIDENTIAL <br /> <br /> 720 MICHAEL ~,Y <br />AU~VILLE <br /> <br />OR 9?925 <br /> <br />CONTRACT CIT~ gGB OCCUPANT LOAD <br />AUNSVI LLE NO NO or <br /> <br />PO BOX 290 <br />AUIvLSVILLE OR 97325 <br />PHONE; 749-2576 <br /> BLOCK <br /> <br />SECTION <br /> <br />TOWNSHIP <br /> <br /> pARCEL <br /> <br /> SITE NUMJgER~ <br />~NS~ALUATION ZON~ <br /> <br />8004 <br /> MAP <br /> <br />167 220 <br /> <br />8S IRREG LOT 2W CORNF. H R~ <br />SF YES NO <br /> <br />51 <br /> <br />TYPE.* ELECTRICAL <br /> <br />CONTRACTOR, NO. <br />LICENSE NO: <br />DEEMING, BRETT <br />PO BOX 290 <br />AUMSVILLE OR 97325 <br />PHONE.* 74g-2576 <br /> <br />PEPC,IIT OR APPLICATION NO: 9017913 <br /> <br /> SUPER'VISING ELECTRICIAN/NUMgER <br /> <br /> ITEM <br />TFJ'flP CONSTR SERVICE <br />FLEET SURCHARGE -ZONE 3 <br />ELECTRICAL STATE SURCHARGE <br /> <br />PAYEE: BERNING, BRETT <br />RECEIVED BY: >o<x <br /> <br />THIS IS NOT A <br /> <br />QUANTITY AIc~DUNT <br /> 1 $30.00 <br /> $8.84 <br /> $1.50 <br /> <br />TOTAL ASSESSED CEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$35.34 <br /> $0.00 <br />$35.34 <br /> <br />BALANCE DUE $0.00 <br /> <br />RECEIPT NO: 19020 <br />TYPE~ IN CHECK ~: 0 <br /> <br />THIS APPLICATION ~UST GO THRETJ~H A REVIEN PROCESS V¢HERE THE <br /> <br />FOLLONING MUST BE C~f4PLETED' IT IS THE RESPONSIBILITY OF THE APPLICANT TO A.~x~URE THAT <br />ALL NECESSARY INFORt4ATION HAS BEEN PEOVIDED. <br /> <br />PLAN REVIEW: BY <br />REMARKS: TEMP <br /> <br />DATE <br /> <br />CITY JURISDICTIOINt; BY ........ <br /> <br />DATE <br /> <br />FORM#MC1556 REV lIN8 OFF]C~ COPY <br /> <br /> <br />