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MARION COUNTY BUILDING INSPECTION <br />S~=NATOR BLDG, NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OR~=GON 97'301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br /> .. 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> I am performing WOrk or~ a property I own or occupy, <br /> I am a registered builder OIq thc' authorized representative S GNATURE OF APPL CA ~"~- ' - i <br /> of a registered builder, <br /> The work will be performed by a registered builder. <br /> O,hc'r ,, <br /> I have read and agree to the terms st~ed on hereve <br /> this document. <br /> <br />OWNER;DATE: 06/05/92 ;¥'irc~E .- ,1"3 ;2' 1 ** "t_o~: : CA~E6ORY; <br /> HAYN~. MiKE RES$ DENI' iAI <br />SI'rUg ADDRESS'. ' OCCUPANCY: <br /> <br /> 625 ~,K S'[ Cgt~TRAd~CITY: , O~E~ :OCCUPANT LOADZ <br /> AU/",TSV i LLE OR 97325 : <br />USE O¢ gUlLOlNC; AUNESVILLE : NO <br /> NO 0¢ 8EDn00MS <br /> <br /> Pro BOX 3'/'1 <br /> AUNcSV.~LLE OR 9?325 3'/'3-8438 <br /> PHONE++ 749-1195 SITE NUFCgER: 92-02001 <br /> VALUAT iON `+ <br />I LOTr BLO~ K'. <br /> <br /> D~PTR; AR~A: UNITS: IRREG. LOT'. ; CORNER: ' <br /> NO '. NO <br /> <br />MAP: <br /> <br />TYPE.* ELECTRICAL PEFaNIi'r OR APPLICATION NO.* 40450 <br /> <br />CONI'RACTOR, NO. <br />LICENSE NO: <br />HAYNES, NiKE <br />POBOX 371 <br />AUMSViLLE OR 9?925 <br />~HONE: 749-1195 <br /> <br />SUPERVISING ELECI'RICiAN/NUIVlBER <br /> <br /> i'fEN <br />BRANCH CIRCUIT, Ni'FHOtJT SERVICE OR FEEDER - 1S'F CiRCUiT <br />ELECTRICAL STATE SURChARgE <br /> <br />(~JAN'FITY AMOUNT <br /> ~ $35.oo <br /> $1_75 <br /> <br />TOTAL ~ED FEES <br />PREVIOUS RECEIPTS <br />'FHIS RECEIPT <br /> <br />$36.75 <br /> ~0+00 <br />$38.75 <br /> <br />BALANCE DUE $0.00 <br /> <br /> PAYEE: HAYNES, NiKE & DOROTHY RECEIPT NO: 42481 <br /> RECEIVED BY.+ TH ...................................................................................... ~__ TYPE: CK CHECK ~.' 4541 <br /> * THIS IS A VALID PE~IT $ THiS PE~IT EXPiRE~ 180 DAYS FA~:I~q IT~ iSE4JE DATE. IF <br />CONSTRUCTION CFJ~ FOR A PERIOD OF 180 DAY~, OR iF CONSTRUCTION FAIL~ TO MEET ALL <br />,~,~HREqUIREMENTS OF STATE ~ AND ~RiON COUNTY BUiLDIN~ AND ZONING ORDINANCES, THiS PER/~iT <br /> ALL BECO~IE NULL AND VOID+ <br /> <br />RENARKS: 1CiR FOR HEAT PUMP <br />DONALD E. IAIOODLEY, r4ARiON COUNTY BUILDING OFFICIAL / BY ........... ~ ........................................................................ <br /> <br />¢OR~ # ~C I~-.~,EV. ,~ OFFICE COPY <br /> <br /> <br />