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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG NO 225 <br />220 HIGH STF1EET NE <br /> SALEM: OREGON 97301 <br /> <br /> PHONE:: 588-5147 8::00 - 430 <br />24 HOUR CODE-A-PHONE:: 588-7904 <br /> <br />I am performing work on a properly I own or oocup~ <br /> <br />of a registered builder <br /> <br />have read and agree to the term8 staled on the reverse side of <br />th~s document <br /> <br />SIGNATURE OF APPLICANT <br /> <br />ow~/~I'£; 0?/30/90 liME: 14:08;53 <br /> LUIVEt ER, FRANK <br />SIIUB ADDHEBS <br /> <br />CONSTRUCTION TYPE OCCUPANC~ <br /> <br />RES 1 DEN l i AL <br /> <br />5160 HOWELL PP~IR~E ROAD <br />AUt'&~VILLE OR 97325 <br /> <br />IISE OF BUILDING <br /> <br />I'4AR I ON 6OUN'i' Y NO <br /> <br /> PHONE: <br /> <br />LOT <br /> <br />BLOCK SECTION TOWNSHIP <br /> <br /> 12 <br />DEPTH AREA UN[TS <br /> <br /> SI1B NUMBER: 10759 <br /> VALUA f 1 ON: <br /> <br />8S 2W EFU <br /> NO NO <br /> <br />MAP <br /> <br />FYPE: EL£CFRICAL PERIvlt f' OR APPLICATION NO: <br /> <br />25912 <br /> <br />CON'I RACI OR, NO. 10875 <br />L .!. CEN~,E NO: <br />CHERRY CI fY BL~G <br />PO 80X 12688 <br />~AL~-M ORE 9?309-0668 <br />~E: 399-?609 <br /> <br />SUPERVISING ELEC1 RiCiAN/NU~EI'~ <br />JON J NOLF <br /> <br /> iIEM <br />i RR i C.~¢. l' i ON PUMP <br />C/i BERV 101-200 <br />FLEEr SURCHARGE -ZONE 2 <br />~-LECIRiCAL SfAI E SURCHARGE <br /> <br />Ot)AN'II'TY AMOUNf <br />1 $30.00 <br />1 $70.00 <br /> $2.58 <br /> $5.oo <br /> <br />1OTAL ~6O FEES <br />PREVIOUS RECEIP1S <br />THIS RECEiPt <br /> <br />$107.56 <br />$?3_84 <br /> $33. ?2 <br /> <br /> ¢~-~-~ BALANCE DUE $0.00 <br /> <br /> RECEiR¥ NOt 2?520 <br /> PAYEE, CHERRY C~ EL~ (,~ / //,¢//¢~ ~ TYPE: OK CHECK ~: 18167 <br /> <br />~T~OTI~ C~ FOR A PBI~ OF 180 ~, OR IF ~TBOTI~ FAi~ TO m~T ALL <br />~I~ OF ~TATE ~ ~O ~I~ ~ BUiLDiNG ~D Z~IN60~IN~O~, THIS <br />~&k BB NULL ~O <br /> <br />R~IVlARK5: 200 AMP SERV/iRR PUMP R;1~3671 R:~3659 <br /> <br />LT.,}NALD E. NOOOLEY. MARiON CY,.~JNi'Y BUILDING OFFICIAL / BY <br /> <br />OFFICE COPY <br /> <br /> <br />