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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 /> I am Derforfding work or~ a property I own or oCCuB,y,~," <br /> l am a registered builder OR ( )theauthorl~ed repfe$entetive <br /> of a registered builder, <br /> '(I)e work wilt be perfomled by a registered builder. <br /> Other. <br /> I have read and agree to the terms stated on the reverse side of <br /> this docur'dent. <br /> <br /> OAf'E: 08/20/90 TIME: <br />OWNER: <br /> REA CONS'I <br /> <br />SITUS ADDRESS: <br /> <br />CATEGORY; <br /> <br />OCCUPANCY <br /> <br />RESiDENF IAL <br /> <br /> 110 4'f'H S'f <br />AUfCLSViLLE <br /> <br />USE OF BUILDING: <br /> <br /> CONTRACT CITY: O~i <br />OR 9?383 <br /> AUIvISv i LLE NO <br /> <br />OCCUPANT LOAD: <br /> <br /> NO OF 8EOR00MS <br /> <br />MAILIHG ADDRESS: .... SUBDIVISION: <br /> <br />PO BOX 8'/? <br />5'fAYTON OR 97383 <br />PHONE; <br /> <br />LO[': BLOCK; <br /> <br /> SiTE NUMBER; 10971 <br /> VALUAT i ON: <br />~EDTION: : ~owNs~41P: ;RANGE: ZONE: <br /> <br />AREA: uNITS: IRREG. LOT: i boRNER: <br /> NO NO <br /> <br />tYPE: ELECIRICAL <br /> <br />CONf'RAC?©R, N©~ <br />L1C'b2NSE NO: <br />I~EA CONB'r <br />PO BOX 617 <br />$~AYI'GN OR 9?383 <br />PHONE: '749-&818 <br /> <br />PERf~4I.'f' OR APPLICATION NO: 2651'7 <br /> <br /> SUPERViSiNG ELEC'T'RiCiAN/NUMBER <br /> <br /> 1 T ENI <br />SERV CHANGE ONLY-EXISTING <br />f'WO OR NYORE NS,~ CiF,%Ui'T'S;ALT OR EXT' <br />FLEEr SURGI~IARGE ~ZONE <br />8'LECTRiCAL STATE SURCHARGE <br /> <br />PAYEE: R~A ~Sf' <br />RECEIVED BY: PB <br /> <br />QUANTITY AHOUN1 <br />I $30,00 <br />I <br /> $8_~2 <br /> <br />'tOTAL ~gD FEES <br />PREVIOUS RECEIPTS <br />'f'H~S RECEIP'f' <br /> <br />$68_12 <br /> $0-00 <br />$88,12 <br /> <br />BALANCE DUE $0,00 <br /> <br />RECEiP'r NO; 28055 <br />TYPE: iN CHECK ~: 0 <br /> <br />~ THIS iS A VALID PER~IT TM THIS PER~iT EXPIRES 180 BAY~ERO~ ITS I,SSUE DATE. IF <br />CONSTRUCTiON C¢_ASES ~OR A PERIOD OF 180 DAYS. OR IF C~TRUO~iON PAILS TO ~EET ALL <br />t~J=~(JUIRE~I-i~TS OF STATE LA~ ~ND I~RION COUNTY BDILDIN6 AND ZONING ORDINANCES, THIS PER~i~ <br />5HALL BE(~:~IE NULL AND VOID. <br /> <br />REMARKS: SERV/CHG 2 CiR <br /> <br />OONALO E_ N~)OLEY, MARION CO'UN'T'Y BUiLDiNG OFFICIAL / BY <br /> <br />FORM # MD 16-'66 R~V. 4/94) OFFICE COPY <br /> <br /> <br />