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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLE)G. 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 pertormfng work on a property I own or occupy. <br /> <br />SIGNATURE OF APPLICANf: <br /> DATE: <br /> <br />OWNER: TAX LOT: <br />s~ru$ ^mDH~SsiS, VERGREEN CON~TRUCTION TYPE' <br /> <br />355 EVERGREEN DR <br /> <br />OR' '9'F325 <br /> AUI'4SVi LLE NO <br /> <br />OCCUPANCY: RE~; D~N'i 1AL. <br /> <br /> PH(]N E: <br />I,,OTr 81.OCK: SECTION: ~0WNSHIP; <br /> <br />SITE NUMBER: 14707 <br />RANeCALLJA'I' 1ON :: ZONE: MAP: <br /> <br />CORNER: <br /> <br />NO NO <br /> <br />TYPE: t:LEC'¥'RICAL PERMIT OR APPLICATION NO: <br /> <br />36422 <br /> <br />(.,'CN/RAt; f'OR, NO_ 2?459 <br />L. 1C~gN.~E NO: <br /> <br />Po 8ox 52 <br />I'~,mnen, 9?392-0000 <br />PHONE: ?43-2546 <br /> <br />SUPERViSiNG ELECTRiCIAN/NUMBER <br /> <br /> I~EM <br />ABB~'I'IONAL. FEES <br />ELEC'TRiCAL STATE SURCHARGE <br /> <br />PAYEE: R <br />RECEIVED BY: CL <br /> <br />QUAN'T'i'i'Y AMOUNi <br /> ] $30,00 <br /> $~.5o <br /> <br />TO'FAL ASSESSED FEES <br />PRg¥iOU5 RECEiPI'~ <br />THiS RECEIPT <br /> <br />$3~.50 <br /> <br />BALANCE DUE $0.0G <br /> <br />RECEIPT NO; 38353 <br />TYPE; CK CHECK ~: 9990 <br /> <br /> THIS IS A VALID PER~iT $ THIS PE$~IIT EXPIRES 180 DAY~ FRO~ ITS iSSUE DAT~. IF <br />C~DNSTRUCTION CEASES FOR A PERIOD OF 1B~ DAYS. OR IF CONSTRUCTION FAILS TO RE~ET ALL <br />F~EQUIRE~F. NTS OF STATE L~ AJfll) RARION COUNTY BUILDING AND ZONING ORDINANCES. THIS PE~II'F <br />~HALL ~E~E NULL AND VOID. <br /> <br />RP,,MARKS: iVlFG SVC R:~3030 <br /> <br />3ONALD E. ~NOOOLEY, MARION COUNTY PJU:[L.0[NG OFF,(CIAL / BY <br /> <br /> OFFICE COPY <br />FOR~ # MC 15-'55 REV, 4,/30 <br /> <br /> <br />