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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 />~ am performin~ work on a property I own or occupy. <br /> <br />SIGNATURE OF APPLICANT: <br /> DATE: <br /> <br />EVERGREEN <br /> <br />RES [ L)~N ] i,AL <br /> <br /> 255 <br />AUM~ViLLE OR <br />L)~E OF BUILDING: <br /> <br />97325 <br /> AUM~ViLLE <br /> <br />UGB: <br /> <br />NO <br /> <br />OCCUPAN~ LOAD: <br /> <br /> NO OF BEDfl00MS <br /> <br />MAILING AOOR£SS: ........ <br /> <br />SUBDIVISION; <br /> <br /> PHONE: <br /> <br />LOT: BI.~CK: SECTION: <br /> <br />TOWNSHIP: <br /> <br />SiTE NUMBER; 14702 <br />VALUA I' tON: <br />mANGE: ZONE: <br /> <br />U NfTS: IRREG. LO~: CORNER: <br /> <br />NO NO <br /> <br />MAP: <br /> <br />ELECTRICAL PERMIT OR APPLICA'f'iON NO: <br /> <br />364,16 <br /> <br />CONTRACTOR, NO. 2?469 <br />LICENSE NOt <br /> R & R E"tecl;r'f¢ Inc <br />Po Box 52 <br />'T'u~ne~, 9?392-0000 <br />PH~E: 743-2546 <br /> <br />~JPERVi$iNG ELEC i'R I C I AN/NUIV~ER <br /> <br /> iTEM <br />ADDITIONAL FEES <br />~L,.EC'T'RICAL SfA'I'E SUAX¢HARGE <br /> <br />QUANTITY AMOUNT <br /> ~ SS0_00 <br /> $'~_50 <br /> <br />TOTAL ~D FEE5 <br />PREVIOUS RECEIPTS <br />'[~HI5 RECEIPT <br /> <br />$37,50 <br /> <br /> ,50 <br /> <br />BALANCE DUE $0, fJ(] <br /> <br /> PAYEE; R & R E'lectpic in¢ RECEIPT NO: 38347 <br /> RECEIVED BY: CL TYPE: CK CHECK ~: 9990 <br /> <br />* THIS IS A VALID P"E~;~VlIT * THIS PE~qIT ~XPIRE~ 180 DAYS FRC~I ITS I~E DATE. IF <br />~T~CTI~ C~ FOR A PERIOD OF ~DD ~YS. OR iF ~ST~CTI~ FAi~ TO ~EET ALL <br />~IR~T3 OF STATE ~ ~D ~RI~ ~NTY BUILOIN~ ~D Z~iNG ORDIN~C~, THi~ ~iT <br />~ALL 8~E NULL ~O ~IO. <br /> <br />R~MARKS: MFG SVC R~3030 <br /> <br />DONALO E_ WOOQLgY, MARION COUNTY BUILDING OFFICIAL / BY <br /> <br />FORM tf MC 15-56 REV. 4/90 <br /> <br />OFFICE COPY <br /> <br /> <br />