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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 performing work on a property I Own or o¢¢~ipy, <br />~ ~m a registered builder OR tile authorized representative <br />of a registered builder, <br />I'ho work will be performed by a registered build¢¢. <br />Other. <br /> <br />°wNg~.l E: '10/28/91 f'ir4E t <br />sITtJs AnnRESSEV'E[g%'4RE EN <br /> <br /> AU~SVILLE OR <br />USE OF BUILD~NG: <br /> <br />16:04:09 <br /> <br />97325 <br /> <br /> TAX LOT~ <br /> CONSTRUCTION TYPE: <br /> CONYBACr CITYI <br /> <br />AIJ~SV I LLE <br /> <br />UGB; <br /> <br />MAILING ADDHESS: <br /> <br />SUBDIVISION: <br /> <br />NO <br /> <br />CATEGORY: <br /> <br />OCCUPANCY: RES t OE.:N 1 ,~ AL <br /> <br />OCCUPANT LOAO: <br /> <br /> F:'H ON E: <br />LOTI BLOCK: SEC'¥1ON: <br /> <br /> 5I'T'E NUIVlBER: 14'/03 <br />' RANG~,ALUA'f'iON: ZONE: MAP: <br /> <br />WIDTH: :DEPTH: AREA: UNrTS: <br /> <br />IRREG. LOT: CORNER: <br /> <br />hlf"~ ,, <br /> <br />[YPE: ELECTRICAL PERMII' OR APPLiCATiON NO: <br /> <br />CONI'RAC]GR, NO, 2?459 <br />LICENSE NOt <br /> <br />PO Bo× 52 <br />fur-non, 9'1392~0000 <br />PHONE: 743~2545 <br /> <br />SUPERViSiNG ELECTRiCIAN/NUMBER <br /> <br />ADDiI~QNAL, ~EES <br />.... EC RiCAL STATE SURCHARGE <br /> <br />QUAN r i/Y ArqOUN f' <br /> I $30_ 00 <br /> $1 , 50 <br /> <br />TOTAL ~ESSEO FEES <br />PREVIOUS RECEIPTS <br />'I"H~S RECEIPT <br /> <br />$3'1 , 50 <br /> $0.00 <br />$31,50 <br /> <br />BALANCE DUE $(~,00 <br /> <br /> PAYEE: R & R E'te~tpf~ 1nc RECEIPT NO: 38348 <br /> RECEIVED BY: CL 'TYPE: CK CHECK ~: 9990 <br /> <br /> * THIS IS A VALID PERMIT · THIS PERMIT EXPIRES 180 DAY~ FROM ITS ISEiJE <br />~5T~CTi~ C~ ~R A PERIODOF 180 ~, OR iF ~ST~CTi~ FAi~ TO MEET ALL <br />~iR~TS OF ~TATE ~ ~D ~RI~ ~NTY BUILDING ~D Z~ING ORDIN~C~, THiS PE~iT <br /> LL BEdE NULL ~D VOID. <br /> <br />REMARKS: MF'G SVC R~3030 <br />DONALD E- ~ODLE¥, ~ARION COUNTY BUiLDiNG OFF'~CiAL / BY ........................................... ~...0.:, <br /> <br />OFFICE COPY <br /> <br /> <br />