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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 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> Other <br /> <br />DATE: 08/31/90 'rtr, lE: 10:58:82 <br /> <br />SIGNATURE OF APPLICANT: <br /> DATE; <br /> <br />;OWNER: R~ oONsT TAx LOT: <br /> <br /> CONTRACT CITY: : UGB: <br />iAU fe~Sv i LLE i NO <br /> <br />SITUS ADDRESS: ; CONSTRUCTION TYPE: <br /> <br /> 110 4TH ST <br /> AUFESVi LLE OR 97383 <br /> <br />PO BOX 617 <br />S'fAYTON OR 9?383 <br />PHONE*. 749-4010 SITE NUIVlBER: <br /> VALUAT i O~: <br /> <br />CATEGORY: RESiDENTiAL <br /> <br />OCCUPANCY: <br /> <br />OCCUPANT LOAD: <br /> <br />10971 <br /> <br />LOT: <br /> <br />BLOCK: SECTtON: TO~/VN~HIPZ RANGE: ZONE: <br /> <br />MAP: <br /> <br />WIDTH: <br /> <br />AREA: ; uNIts: IRREG, LOT: NO <br /> <br />TYPE: ELECTRICAL <br /> <br />CoN'r RAC'fOR, NO. <br />LICENSE NO: <br />REA ODNST <br />PO BOX 617 <br />STAY1ON OR 9?983 <br />PHONE: 74,9-4010 <br /> <br />PERMIT OR APPLICATION NO: 26517 <br /> <br /> SUPERViSiNG ELEC'rRICIAN/NUMBER <br /> <br /> ITEM <br />SERV 614ANGE ONLY-EXISTING RESIDENCE <br />'f'~O OR MORE NEN CiRG~II'S;ALT OR EXT <br />FLEE'[' SURCHARGE -ZONE 3 <br />ELECTRICAL SI'A'T'E SURCHARGE <br /> <br />PAYEE: REA CONS'[' <br />RECEIVED BY~ OL <br /> <br />f~P.N'f'ITY <br /> 1 <br /> 1 <br /> <br />TOTAL~ESSEO:F~ES <br />PRE¥IOUs RECEIPTS <br />'fBI3 RECEIPT <br /> <br /> BALANCE DUE <br /> <br /> RECEIPT NO: <br /> <br />$30.00 <br />$30.00 <br />$3,84 <br />$3.oo <br /> <br /> 68.12 <br /> -$1.28 <br /> <br /> SO.DO <br /> <br />28454 <br /> <br />~ THI3 I~ A VALID P~IT m~HI~ PEI~iT EXPXRE~180 DAYSFI;~I iT~ iEx.q~E QATE. IF <br />~ST~CTI~ ~ FOR A PBIODOF 180,~Y5. OR IF~S~CTI~ FAI~ TO MEET ALL <br />~I~TS OF ~TATE ~ ~O~ ~NTY 8UILDI~ ~D Z~ING ORDIN~C~, THI~ PE~IT <br />~ALL B~E NULL ~D VOID: <br /> <br />REt4ARKS: SERV/CHG 2 CIR <br /> <br />DONALD E. WOODLEY, r4ARiON G~OUNTY BUILDING OFFICIAL / BY <br /> <br />OFFICE COPY <br /> <br /> <br />