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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 />read and agree to the terms stated on the reverse s~de of <br /> <br />SIGNATURE OF APPLICANT <br /> DATE <br /> <br />OWN~AfE: '10128/91 174E; 16:12:53 <br /> <br />SITUS ADDRES~PAMMON~, DICK ~ DgLORE~ <br /> <br />TAX LOT <br /> <br />CONSTRUCTION TYPE <br /> <br /> CONTRACT CITY <br /> <br /> AUMSV J LL~ OR 9?325 <br />(I,~E OFBUIL D/N(J <br /> AU~¥1LLE <br /> <br />UGS <br /> <br />NO <br /> <br />OCCUPANT LOAD <br /> <br />MAILING AOBHESS SUBDIVISION <br /> <br /> 11373 MtLL CREEK RD <br /> AU~SV~LLE OR 9'7325 <br /> PHONE*. ?69-??44 <br />tOT SLOCS <br /> <br />SECTION TOWNSHIP <br /> <br /> EVERGREEN MOB t L~ ~51A l B5 <br /> <br />SiIE NUMB F-.,R: 14557 <br />[~ANN4EALUAI- ION: ZON~ MAr <br /> <br />WIDTH 39 DEPTH AREA ~ UNITS ~ IBBEG LOT <br /> 6~ ',_" ~ 4575. $~ NO NO <br /> <br />fYP~: ELECf RiCAL <br /> <br />CONIRACTOR, NO. 2?459 <br /> <br />Po Box 52 <br />Turnar, 97392-0000 <br />PHONE: ?43-2546 <br /> <br />PERMIF OR APPLICAFION NO: 35~20 <br /> <br /> SUPERViSiNG ELECTRiCiAN/NUMBER <br /> <br /> I1EM <br />ADOIFiONAL FEES <br />~L. ECIRiCAL 5IA1g ~URCHARG~ <br /> <br />QUANiiTY AMOUNT <br /> $3o.oo <br /> <br /> IOFAL 4SSE~D Fg~ $3~_5u <br /> PREVIOUS R~EIPI~ $1~_(~o <br /> fHiS RECEIPT $~1.b0 <br /> <br /> 8ALANC~ 0ME $f.)0tl <br /> <br /> PAYEE: R & R Etec~ric thc RECEIPT NO: 3835~ <br /> RECEIVED BY: CL 1YPE: CK CHECK ~: 9990 <br /> <br />~ THIS IS A VALID PER~iT ~ THiS PE~IT E~PiRF_.,.~ 180 ~YS F~ ITS I~E DATE. IF <br />~ST~CT~ C~ FOR A PERIOD OF ~80 ~, OR ~F ~ST~CTZ~ FA~ TO MEET ALL <br />RE~iRB~T3 OF STATE ~ ~O ~EI~ ~NTY BUILDiN~ ~D Z~iNG ORDIN~CB, THi8 PEril' <br />~ALL B~E NULL ~B~IB. <br /> <br />REMARKb.; tvIh~ SVC R~3030 <br /> <br />L)()NALL~ F. wOODLbY, MARION COUNTY 8UZLDING OPPICiAL / BY <br /> <br />OFFICE COPY <br /> <br /> <br />