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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG NO 225 <br />220 HIGH STREET NE <br /> SALEM, ©REGON 97301 <br /> <br /> PHONE:: 588-5147 8::00 - 4;30 <br />24 HOUR CODE-A-PHONE:: 588-7904 <br /> <br />of a registered builder <br /> <br />Other <br /> <br />SIGNATURE OF APPLICANT <br /> BATS <br /> <br />owO~Et 12/18/90 III~IE: 1§:06:4f~ <br /> <br />S~TUS AD0~E~~'DSF-~HAUS* ,OORiS <br /> <br />TAX LOT C/'TEGORY <br />CONSTRUCTION IYPE OCCUP&NCY RE,~i DEN IIAL <br /> <br /> 235 E~'ERGREEN DR <br />AUMSVILLE OR 97325 <br /> <br /> CONTRACT CITY UGS OCCURANT LOAD <br />13 <br /> <br /> AUME, VI LLE NO No ok <br /> <br /> P.O. BOX 157 <br /> AUfo!SVlLLr';, OR 9'/'325 <br /> PHONE: 749-152? <br />LOT mt OCK <br /> <br /> EVERGREEN f4OSILE <br /> <br />SI1E NUIViIBER: 11928 <br />RA~LUA'IION: ZONE <br /> <br /> IRREG LOT CORNER <br />%F NO NO <br /> <br />[IYPE: ELECTRICAL <br /> <br />(2ONIPJ&CIOR, NO. 25071 <br />LiCEJNSE NO= <br />CANBY ELEC1RIC <br />790 $ IVY <br />CANBY, OREGON 97013 <br />PHONE: 268-?8?8 <br /> <br />PER~I'I' OR APPLICAIloN NO: ~9280 <br /> <br /> SUPERViSiNG EL~'IRiCIAN/NUF~ER <br /> DANIEL O ONION <br /> <br />ELECIRiCAL SIAIE .SURCHARf~E <br /> <br />TOTAL A,~i,~EC%,~ED <br />PREP¢iOU$ RECEIPI$ <br />THIS RECEIPT <br /> <br />QUANIIIY A~'FJUN~ <br /> 1 $35.00 <br /> <br />$36.75 <br />$38.75 <br /> $0.o0 <br /> <br />BALANCE B~E $9.00 <br /> <br />PAYEE: RECEIPT NO: <br />RECEIVED BY: ¢1 IYPE: CHECK ~: 0 <br /> <br />* THIS iS A VALID PER'lIT ~ THiS PER~41T EXPIRE~ 180 [~Y~ FRO~ ITS IE~,UE DATE+ iF <br />CONSTRUCTION CEA~-'~ FOR A PERIOD OF 180 DAY~, OR IF CONSTRUCTION FAIL~ TO ffi15ET ALL <br />REQUIREME~ITS OF STATE LAt~ .eND MARION COUNTY BUILDING .aJ~D ZONING ORDINANCES, THiS PEI~ilT <br />ECciALL BEI:X~E NULL ANOVOIO. <br /> <br />RF.J~a. RKS: MOBILE HOME CONN <br />OONALO E. I,'~OLEY, MARION COUNIY BUILDING OFFICIAL / BY ...... ~ ................ <br /> <br /> OFF[CE COPY <br />FORM # MC 15,56 REV 4/90 <br /> <br /> <br />