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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 /> <br />Othor <br /> <br />OWNER <br /> DATE: 05/28/91 TINE; <br /> <br />SITUSAOonEs~OLOUBEK,ROBERT <br /> <br />9:36;40 <br /> <br />CONSTRUCTION TYPE 902~ --~ 50 OCCUPANCY <br /> <br /> 200 SANIIAM AVB <br />use <br /> <br />OR 9. 342 <br /> <br /> CONTRACT CITY <br /> <br />DE T ROi I <br /> <br />uo@ <br /> <br />NO <br /> <br />2150 34TH AVE N~ <br /> <br />SECTION TOWNSHIP <br /> <br /> HANNOND <br /> <br />~i 'f E NUMBbR; <br /> NC~ALUA f iON: ZONE <br /> <br />126 ?4 <br /> <br />9 <br /> <br />'50 lou <br /> <br />2 t0 5E <br /> <br />[YPE: ELECIRiCAL <br /> <br />CONiRACIOR, NO. <br />LICENSE NO: <br />HOLOUBEK,k%~CERI <br />2150 34tH AVE NE <br />'&ALEN, OR 9/303 <br />PHON~; ~63-5578 <br /> <br />PaRNII OR APPLICATION NO: 32495 <br /> <br /> SUPERVISING ELECIRtCiAN/NUMBER <br /> <br /> 1 T'kN <br />MANUFACTURED HONE SERViCE/FEEOER <br />kLECT RICAL SiAl~- i:¢URCHARGE <br /> <br />PAYEE: HOLOIJBEK,k'(,.'~ERi <br /> <br />TOTAL A~6~ED FEES <br />PREVIOUS RECEIPTS <br />'fHI~ RECEIPT <br /> <br />Q~JAN Ti fY ANOUN i <br /> 2 $'?0.00 <br /> SS- 5U <br /> <br />$?3.50 <br /> $o.o0 <br />$'/3.50 <br /> <br />BALANCE DUE $0_00 <br /> <br />RECEIPT NO: 3428~ <br /> <br /> RkCklVkD WY~ cl IYPE: CK CHECK ~: 1113~ <br />* IHI5 is A VALID PERPliT * THI~ PER~iT EXPiREI5 180 [lAYS FRO¢,I ITS I~E~JE DATE. IF <br />CONSTRUCTION CEASES FOR A PERIOD OF 180 OAYS. OR IF CONSTRUCTION FAiL~ TO ~EET ALL <br />REqiJiRE~I~TS OF STATE ~ AND fi/tRioN CI2UNTY BUILDING ~N~D ZONING ORDINANCES, THiS PER~IT <br />,~HALL 8ECOOlE NULL AND VOID. <br /> <br />REN~RKS: NH SVC/CON R~844'? <br /> <br />0ONALD E, WOODLEY, NARiON COUNTY BUILDING OFFiCiAL / BY <br /> <br /> OFFICE COPY <br />FORM # MC 16-66 REV 4/~0 <br /> <br /> <br />