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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 a registered builder OR I the au hori~ed rep esen a ye <br />efa registered builder <br />¥1~e ¢,ork will be performed by a registered budder <br />Other <br />I hu¥c read and agree fo the terms stated on tee reverse side of DATE <br /> <br /> OAfb: 05/24/91 FINE: 11:52:09 <br />OWNER fAX LOT' <br /> EVERGREEN <br /> <br /> 250 EYERGRE-~4 DR -- CONTRACI CItY UGB <br />AUIv~vi LLb OR 9?325 <br /> AMIv~VlLLE <br /> <br />NO <br /> <br />RE$i O[7,N fiAL <br /> <br />F~dQNE: <br /> <br />(_0) ~LOCK SFCTION TOWNSHIP <br /> <br />OCCUPANT LOAD <br /> <br />EVERGREEN MH <br /> <br />Si fE NU~r-R: 13069 <br />VALUAi iON .+ <br />~AN(~E ZONE <br /> <br />NO NO <br /> <br />MAP <br /> <br />I'YPE; ELECFRiCAL PEF~4if OR APPLICAtiON NO: <br /> <br />32452 <br /> <br />CONIRACfOR, NO. 2'7459 <br />LICENSE NO: <br />R b R ELECTRIC <br />P.O. BOX 52 <br />TUk~N~R. OREGON 9?392 <br />PHONE: ?43-2546 <br /> <br />.!J~JPERViSING ELECiRICIAN/NUC4BgR <br />RU~gLL RICE / 1673~5 <br /> <br /> ItEM <br />NANUFACIURED HONE SERVICE/F~D~R <br />ELECtRiCAL 5YALE SURCHA~E <br /> <br />PAYgg; R & R ELECYRiC <br /> <br />FOFAL ASSE~ED FEES <br />PREViOJ8 RECEI P1 $ <br />THiS RECEiPf <br /> <br />QUAN Il 'fY AIvIOUN f <br /> 1 $35_ 00 <br /> $1_ !b <br /> <br />$36 ,, 75 <br /> $0.00 <br /> <br />BALANCE DUE $0_ ut} <br /> <br />RECEiPF NO: 34239 <br /> <br /> RECEIVED BY: OL TYPE; CK CHECK ~: 9584 <br /> <br />* THIS IS A VALID PEf~41T * THIS PERMIT EXPIRES 180 DAyS FI;~I~I ITS ISSUE OATE. IF <br />CONSTRUCTION CEASES FOR A PERIOD OF ~0 DAYS, OR 1F CONSTRUCTION FAILS TO ~EET ALL <br />REJ~JiRE~]TS OF STATE LAW~ ANO I~t~RION COUNTY BUILDING AND ZONING ORDINANCES, THIS PERMI'I <br />~tALL 8E"CO~E NULL ANDVOID. <br /> <br />REMARKS: ~H bVC R~B440 <br /> <br />~)NALD E_ WOODLEY, MARION COUNTY BUiLDiNG OFFICIAL / BY <br /> <br /> OFFICE COPY <br />FORM ~ MC 15 58 R~V <br /> <br /> <br />