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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:O0 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> The work will be performed by a registered b~ilder. <br /> Ct h6, r <br /> <br />DA're= 08/29/90 'riME: 16.~17~46 <br /> <br /> EPPERLY, CI-fARL ES <br /> <br />SITUS ADDRESS~ <br /> <br /> 9193 ~;~'tAIAI SQUARE RD <br />AUt'ISV I LLE OR 9?925 <br /> <br />SIGNATURE OF APPLICANT: <br /> <br />DATE: <br /> <br /> TAX LOT; <br /> <br /> CONSTRUCTION TYPE: <br /> <br />~RiON CC~N TY NO <br /> <br />CATEGORY: <br /> RES l DEN '1' 1A L <br /> <br />OCCUPANCY: <br /> <br /> SiTE NUI',lBER: 11065 <br /> VALUATION: <br /> <br />SEC~[0N; ! ~O~NSH~P: ' RANGEI ZONE; <br /> <br />~RE~: UNITS: IRREG. LOf: NO COR N~0 <br /> <br />MAP: <br /> <br />TYPE: ELECTRICAL <br /> <br />CONTRACTOR, NO. 20098 <br />LICENSE NO: <br />'I'EC~ ELECTRIC <br />P.O. BOX 671 <br />SALEN, OR~ 97308 <br />PHONE: 370-7747 <br /> <br />PERI~Ii'F OR APPLICATION NO: 26844 <br /> <br /> ~UPERViSING ELEC'f'RICiAN/NUC4BER <br /> R. STEiNSROOK <br /> <br /> l TEM <br />SERV CHANGE ONLY-EXISTiNG RE~iDETNCE <br />FLEET f~JRCHARGE -ZONE 3 <br />ELECTRICAL STATE SURCHARGE <br /> <br />OUANTITY AhlOUNf <br /> 1 $30.00 <br /> $3.84 <br /> $1+50 <br /> <br /> TOTAL A,.%5~O ~EE,~ $35.34 <br /> THZ$ R~CEJPT <br /> ~ALANoE ~E $o.o0 <br /> <br /> PAYEE: 'rEco ELEC'f'R[C RECEIPT NO: 28399 <br /> RECEIVED BY: PR TYPE: CK C~4ECK ~: 68?9 <br /> <br /> ~ THIS IS A VALID PEI~4iT * THIS PERIWIL.T EXPiRE~IS0 0AYS t:RO~ ['¢~ I~8LtE OATE. IF <br />CONSTRUCTJCN CEASES FORA PERiOD OF 180 DAY~¢OR IFC~N~TRUCTIQN ¢A[LS TO I~BET ALL <br />~E3~JIRI~4ENTS OF STATE I_ANSANDI~ad~ION COUNTY BU[LOIN6AND ZCNIN60ROJNANCIBS, THIS PER~[T <br /> ALL 8ECOI'4ENULLANDVO]D. <br /> <br />REMARK.S: ~ERV CHG Rl~t3214 <br />0ONALO E~ h~'~LEY, I~RI~N GClJNTY BUiLD,I.N~ OFFiCiAL / ~Y .......................................... ~: ....................................... <br /> <br /> OFFICE COPY <br />FORM # MC 15.56 REV. 4/90 <br /> <br /> <br />