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MARION COUNTY BUILDING INSPECTION <br />SENATOR IBLDG, NQ, 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 performing work on a property J own or occupy : <br /> I am a registered buiJder OR the authorized representative <br /> of a registered builder,, <br /> The work will be pedormed by a registered builder <br /> Other <br /> I have read and agree to the terms stated on the reverse aide of <br /> <br /> DATE: 09,/13/91 ]'IME: 12:00:15 <br />I 8AT~. teARY <br /> <br />!'S~TUS ADOF~ESS <br /> <br />SIGNATURE OP APPLICANT <br /> <br /> DATE:: <br /> <br />TAX LOT CATEGORY <br /> 56274-000 <br /> <br />CONSTRUCTION TYPE OCCUPANCY <br /> <br />I 9624 MILL CREEK RD SE <br /> AU~VILLE OR 97325 CONTRACT CITY:: UGB:: <br /> <br />~ NO <br />)USE OF eoE~N~ ..... <br /> <br />: MAILING A~)~)~E~ .......................................................................... <br /> SU BD~VISION <br /> <br /> PHONE: 749-2846 <br /> <br />LOT ?BLOCK <br /> <br />ITOWNSRi'p' * <br /> <br /> NO <br /> <br />~IIE NUMBER: VALUA r I ON <br /> <br />I~EG LOT <br /> <br />TYPE: ELECT RiCAL <br /> <br />CONI RAC IOR, NO. <br />L i Cf;gNSE NO: <br /> GARY <br /> <br />PMrJNE: 749-2848 <br /> <br />PERMII OR APPLiCATiON NO; 9035142 <br /> <br /> · SUPERVISING EL6Cf RICiAN/NUM~ER <br /> <br /> ii-EM <br />BRANCH CiRg;Ui[~ - FWO FC FEN <br />t"LECI R i GAL b I A l b ~ RL~ARGE <br /> <br />lO'KAL A~ED ¢EES <br />PREWI(Td,$ RECEIPTS <br />~HIS,RECEIP~. <br /> <br />BALANCE ,[..~E <br /> <br /> (.~ANIlTY <br /> I $50.00 <br /> <br /> $52.50 <br /> $o.oo <br /> $52.50 <br /> <br /> SO.CO <br /> <br /> 37048 0 <br />A I~-VI~ PRC~2E~I~4ERE THE <br />THE APPLI~T TO ~RE THAT <br /> <br /> PAYEE: <br /> BATES, <br /> r, AARY <br /> ' ~/7'~ ~ ~! RECEIPf NO: <br />RECEIVED BY: PB ~_J~_. ~, .."-'~TYPE:_iN _~ECK <br />* ~IS i$ NOT A PE~iT. ~i~ <br />~L~ING ~ST BE <br />~L N~ INF~TI~ <br /> <br />PLAN REVIEW: ~Y <br /> <br />REMARKS: CIRCUitS <br /> <br />.DATE <br /> <br />IGIlON: BY ........... DArk ........... <br /> <br /> <br />