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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 perforr31n9 work on a property I own or OCCUpy. <br /> I 8m a registered builder OR the authorized representative <br /> e a red Stered bu Ider, <br /> The work will be performed by 8 reDiStered builder. <br /> Other .... <br /> ~ have read 8f~(J 8(iliad to the ~erms stated on the reverse side of <br /> this decument. <br /> <br />OWNE~: <br /> <br />SIGNATURE OF APPLICANT: <br /> DA'f E: <br /> <br /> TAX LOTz <br /> <br /> CONSTRUCTION TYPE: <br /> <br />CATEGORY: <br /> <br />AUC4~3V] LL.E OR 9?325 <br /> AUIVlSV 1 LLE NO <br /> <br />MAILING ADDRESS: <br /> <br />SUBDIVISION: <br /> <br /> PHONE: <br /> <br />LOT: <br /> <br /> SiTE NUMBER: 14692 <br /> VALUATION: <br />BLOCK; , SECTION: TOWNSHIP: RANGE: ZONE; <br /> <br />DEPTH: <br /> <br />AREA: UNITS: IRREG. LOTZ CORNER: <br /> NO , NO <br /> <br /> RESt [)ti!N 'T' .[ ,AL <br />OCCUPANCY: <br /> <br />OCCUPANT LOAD: <br /> <br />NO OF BEDROOMS <br /> <br />TYPE: ELECTRICAL PEPJfll'f' OR APPLiCATiON NO: 36394 <br /> <br />CONTRACTOR, NO. 2?459 <br />LtCENSE NO: <br /> R & R E"leotpfic ina <br />Po ~ox 52 <br />Turner. 97392-0000 <br />PHONE~ ?43-2546 <br /> <br />SUPERViSiNG ELECTRiCIAN/NUMBER <br /> <br /> iTEM <br />ADDI'fiONAL F'EE~ <br />Et-EC'f'RtCAL S'I'A'T'E SURCHAF. tCGE <br /> <br />QUANT1]'Y AMOUNf <br /> $30.00 <br /> <br />TOTAL ASSE~ED FBE~ <br />PREVIOUS RECEIP]'~ <br />'FHiS RECEIPT <br /> <br />$31.50 <br /> $o. oo <br /> <br />BALANCE DUE $0.00 <br /> <br /> PAYEE: R & R E"lectrffc tn~ RECEIPT NO: 38325 <br /> RECEIVED BY: CL TYPE: OK CHECK ~: 9990 <br /> *TH]S IS A VALID PER~IT * THiS PEF~iT EXPIR~ 180 DAYS FROt,1 iTS I,~.,~JE DATE. IF <br />OON~TRUCTION CEA~mA FOR A P~RZOD OF ~80 OAY~, OR IF CONSTF~IJOTiON FAILS TO ~EET ALL <br />5,~-~U~I~I~ENTS OF STATE LAWS ANO I~ARiON COUNTY BUILOiNG AND ZONING ORDINANCES. THIS PER~IT <br /> ALL 8EC(~E NULL AND VOID. <br /> <br />REIV'ARK~: ~FG SVC <br /> <br />OONAL0 E. WOOOLEY, NARIr.~ COUNTY BUJLDING OPFiCtAL / 8Y ..................................... <br /> <br />OFFICE COPY <br /> <br /> <br />