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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, N~), 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 /> I am perforn~ln9 work on 8 property I own or occupy, <br /> lam a registered builder OR ( )theauthorizedtepfesentetive <br /> of a registered builder. <br /> 7he work will be performed by a registered builder. <br /> Other <br /> I have read and agree to the terms stated on the reverse sfde of <br /> this document. <br /> <br />OWNER: KI LROYB Iv'C, NUFACTU RED <br /> <br />SITUS AC0RESS: <br /> <br /> 11873 'f'HRU~H CT <br /> AURORA <br /> <br /> ' "AX LOT; <br /> <br /> i 60~fr~UCT~O~ <br /> <br />NE 22 [ <br /> <br />MAILING ABDRESSz <br /> <br /> ARDNT RD <br /> <br />OR 97002 ] CONTRACT CITY: i UGg: <br /> I~AR i ON Cr, AJN TY NO <br /> <br />PHr.~IE~ 981-0146 <br /> <br />CATEGORY: RESi DEN I'IAL <br /> <br />OCCUPANCY: <br /> <br />, OCCUPANT LOAD: <br /> <br />TYPE: ELfSC'rRiCAL <br /> <br />CONTRACTOR, NO. 35151 <br />LICENSE NO: <br />PARKIN E~ECI'RiC iNC <br />RT 5 BOX ?g-K <br />BHE~D 97140 <br />PHONE: 246-1301 <br /> <br /> MAP: <br />EP'U 1 <br /> <br />PERf4iT OR APPLICATION NO: 29430/-/ <br /> SUPERViSiNG ELECI'RiCiAN/NUME, ER <br /> 896-B <br /> <br /> I'I'E~ <br />MANUFAC'rURED HOME BERV[CE/FEEOER <br />ELECTRICAL STATE SURCHARGE <br /> <br />q~AN'fIl'Y <br /> 2 $70.00 <br /> $3.50 <br /> <br /> TOTAL ASD~ED FEE5 <br /> PREVi¢.~S REC¢IPTB <br /> THIS RECEIPT <br />:: BALANCE DUE <br /> RECEIPT NO: <br /> TYPE: CK CHECK <br /> <br />$73.50 <br /> $0.00 <br />$73.50 <br /> <br /> $0.OO <br /> PAYEE~ PARKIN ELEC'f~IC iNC 3109'i¢//'~' <br /> RECE. IVgB BY: OM2 5459 <br /> <br />~ THiS I8 A VALID PERMIT ~ THI$::PER~IT EXPIRE~ 180 ~ F~ ~'FS i~E ~I'E. iF <br />~T~CTJ~ C~ ~R A PERZO0 OF 180 ~, OR [F ~ST~CT[~ FA[~ TO ~EET ALL <br />~IR~TS OF ~'fAT~ ~ ~D ~i~ ~ILD[~ ~O Z~IN~ ORDiN~C~, THIS PEril' <br />~ALL BEdE NULL ~O ~lO. <br /> <br />RE~ARKS: SERV/CONN R~790 <br /> <br />DONALD E. NOODLEY, ~ARION CC~JNI'Y BUiLDiNG OFFICIAL / BY <br /> <br /> OFFICE COPY <br />FORM # MC 15-56 REV. <br /> <br /> <br />