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MARION COUNTY BUILDING INSPECTION <br />SENATO~ BLD.C..~. NO. 225 <br />220 HIC~"H 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 />The work will be performed by a registered builder, <br />Other <br /> <br /> MI LLiCAN, BiLL <br />SITUS ADDRESS: CONSTRUCTION <br /> <br />CATEGORY: <br /> <br />OOCUPANCY: <br /> <br />DEN'f' l AL <br /> <br /> 115 8UT're' 8'r ~ CONTRACT CITY: <br />BEI'F4CD 11' OR 9?342 <br /> <br />MAILING ADDRESS: ~ SUBDIVISION'. <br /> <br />P.O. BOX 484 <br />OETROI'r, OR 97342 <br />¢.~IONEz 854-3626 <br /> <br />50 100 ; 5000. , <br /> <br /> Sl TE NUI~JER: 11178 <br /> VALUA'I' I ON .~ <br /> <br />10 5E R-5 <br />8F NO NO <br /> <br />MAP: <br /> <br />105 <br /> <br />'fYPS: ELEC'I'RICAL <br /> <br />CONTRACTOR, NO. &4248 <br />LICENSE NO: <br /> <br />P.O.BOX 1180 <br />PHiLOMATH, OR 9?370 <br />PHONE: 929-3124 <br /> <br />MANUFACTUR~B HOME SERVIO£/FEEOER <br />ELECTRICAL ~TAI'E E~URC~ARGE <br /> <br />PAYEE: CCN~JMER I~g~ER iNC. <br />RECEIVED BY~ L,~12 <br /> <br />PER~IT OR APPLICATION NO: 28309 <br /> <br /> SA.IPERVi$~NG ELEC'~'RIOtAN/NUfC~R <br /> 3080-5' <br /> <br />QUANT I l'Y <br /> 2 <br /> <br />TOTAL <br /> PREVIOUS <br /> THiS RECEIPT <br /> <br />BALANCE DUE <br /> <br /> RECEIPT NO: <br />TYPE: CK C~ECK ~: <br /> <br /> $70.00 <br /> $3.50 <br /> <br /> $73.50 <br /> Some <br /> $73.50 <br /> <br /> $0,00 <br /> <br />29909 <br />51103 <br /> <br /> THIS IS A VALID PERMIT :~ THIS PERi, IT EXPIRE~ 180 DAY~ FR(~ iTS I~E ~TE. iF <br />~ST~CTI~ C~ ~R A ~lOO ~ 180 ~, OR iF ~T~CTI~ FAI~ TO MEET ALL <br />R~IR~TS ~ STATE ~ ~D ~1~ ~NTY BUILDING ~D Z~ING ORDINal, THIS PE~IT <br />~L 8E~ ~LL ~O <br /> <br />RF_2V~ARKS: SERV/CONN R~4491 <br />DONALD E. NOODLEY, MARION COUNTY BU[LD[N~ OFFiCiAL / BY ....................... .._~ ...................................... <br /> <br /> OFFICECOPY <br />FORM # MC 15-56 R~. 4/90 <br /> <br /> <br />