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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 />SIGNATBRE OF APPUCANT: <br /> DATE: <br /> <br />owN~TE; t0'/2S/91 'T'~ME; 12:12:55 <br /> <br /> EVERGREEN <br />SITUS ADDRESS: <br /> <br />TAX LOT: <br />CONSTRUCTtON TYPE: <br />CONVRAOT CITY: UGBi <br /> <br /> 220 YEW~;~C~ -- <br /> AUMSV.[LLE OR 9?325 <br />USE OF BUlLDfNG: <br /> <br />AUIVLSVILLE NO <br /> <br />SUBDIVISION; <br /> <br />CATEGORY: <br /> <br /> RESI DEN ! Ig:~ <br /> <br /> PHONE <br /> <br />LOT: <br /> <br />BLOCK: SECTION: <br /> <br />WIDTH: 'DEPTH: AREA: <br /> <br />SI'f'E NUMBER: 14,593 <br />VALUA [' ~,~: <br />RANGE ZONE <br /> <br />NfO <br /> <br />CORNER: <br /> <br />MAP: <br /> <br />'IYPE: ELECTRICAL <br /> <br />CO~ [RACI'©R, NO_ 2?459 <br />L].CENSE NO: <br /> <br />Po Box 52 <br />Turner, 9?392-0000 <br />~,tflONE~ ?43-2546 <br /> <br />PERMIT OR APPLICATION NO: 36393 <br /> <br /> SUPERVISING ELECTRiCiAN/NUMBER <br /> <br /> ,ITEM <br />ADOi'FiONAL FEE~ <br />ELECTRICAL STATE SURCHARGE <br /> <br />QUANT['TY AIv~UNI <br /> ~ $30.00 <br /> $1.50 <br /> <br /> TO'¥AL A~E~ED FEES $31.50 <br /> PRE¥IQUS RECEIPTS $0.00 <br /> 'tH IS RECEi P'r $31,50 <br /> <br /> BALANCE DUE $0.00 <br /> PAYEE: R & R g"l~ric thc RECEiP'r NO: 38320 <br /> RECEIVED BY: CL fYPE¢ CK CHECK ~: 3030 <br /> <br />~T~OTI~ O~ FOR A PERIOD OF 180 ~, OR IF ~T~CTI~ FAi~ TO ME~' ALL <br />~IR~TS OF STAT6 ~ ~8 ~Ri~ ~NTY BUILOiN6 ~O Z~IN6 ORDIN~C~, fHl~ PE~iT <br />~ALL 8E~E NULL ~O VOID. <br /> <br />REMARKS: r4FG SVC R~3030 <br /> <br />DONAL0 h'. I/~OODLEY, MARION COUNTY 8UtLDiNG OFP[CIAL / BY <br /> <br />OFFICE COPY <br /> <br /> <br />