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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 />06/18/91 I I1'412: 9:15:30 <br /> <br />KAUFt4AN , RO8ER f <br /> <br />SIGNATURE OF APPLICANI <br /> <br /> DATE <br /> <br /> TAX LOT <br /> <br /> GONSI~UCTIQN TYPE <br /> <br />RESIDENT iAL <br /> <br /> 250 EVERGREEN DR <br />AUNC:SV i LLE OR 97525 <br /> <br />5 CONTRACT CITY <br /> <br /> AUt'~Yl LEE <br /> <br />UGB <br /> <br />NO <br /> <br />OCCUPANT LOAD <br /> <br /> NO O~ BEDHOOMS <br /> <br />SUBDIVISION <br /> <br />EVERGR~-EN Iv~ ESTAiES <br /> <br />PHONE: ?89-??44 <br /> <br /> 5 25 <br /> 5b 89 <br /> <br />5F <br /> <br />Si fE NUIVEiER: 13069 <br />VALUAI iON: <br /> <br /> 2W <br /> YES NO <br /> <br />MAp <br /> <br />fYP~,: I=t. ECIRiCAL PERFIiI OR APPLiCAtION NO: <br /> <br />33041 <br /> <br />C,~ON 1RAC 1 OR, ND. 38238 <br />L,((.;.SNSE NO: <br />5ANT iAJVl f'C'3BIL£ HOl'flg5 <br />11373 MILLCREEK RD SE <br />AUf45Vi LLF OR 9?325 <br />PHONE-_ <br /> <br />SUPERVISING ELECI RiC1AN/NUNBER <br /> <br /> QUANTITY <br /> 1 <br /> <br />tOTAL AS.SE~EO FEF_,,S <br />PREVIOUS REC£IPI'5 <br />tHIS RECEIPT <br /> <br />BALANCE DUE <br /> <br /> $35.00 <br /> Si.tx <br /> <br /> $o.oo <br /> <br /> $o.8o <br /> <br />34842 <br /> 8 <br /> <br /> PAYEE: S,~¢4fIA~ F4fJ81LE HONES. RECEIPf NO; <br /> RECEiVAD BY: PR iYPE: iN C~ECK ~: <br /> <br /> · THIS tS A VALID PERI',I~T * TH18 ~E~1T ~PiR~ 180 ~ F~ ITS I~E ~TE. 1F <br />~S~CTi~ C~ ~OR A PER~OD OF 180 DAY~. OR JF ~T~CTJ~ FA~ TO NEET ALL <br />~I~T~ OF STATE ~ ~D ~Ri~ ~N~ BUILDING ~O Z~ING ORDIN~C~, THIS ~iT <br /> ALL BEdE NULL ~D ~iD. <br /> <br />NbF4ARKS: EL CONN <br /> <br />DONALD E. NOOOLEY, MARION COUNfY BUILDING OFFICIAL / BY <br /> <br />FORM/~ MC 15-56 HEv 4/90 OFFICE COPY <br /> <br /> <br />