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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />290 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> OWNER: <br /> BARLOW~ <br /> <br />iSITUS ADDRESS: <br /> <br /> PHONE:588-5147 8:00- 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am a registered builger OR ( ) the author[zed representative SIGNATURE OF APPLICANT; <br />of a registered builder, <br />The work will be performed by a registered buil(~er, <br />Other <br />I have read and agree to the terms stated on the reverse side of DATE~ <br /> <br /> DATE: 07/09/92 TIME." ,15:33."41 <br /> TAX LOT[ i CATEGORY: <br /> THOMAS RESICENTIAL <br /> <br />u~E OF b01L_blNG; .................................. : <br />MAILING ADDRESS: SU DGIVI$1ON: <br /> <br />WIDTH: <br /> <br />SAME <br /> SITE NUMBER: 92-025D4 <br />PHONE: 749-1782 VALUATION: <br /> <br /> NO NO <br /> <br />TYPE: ELECTRICAL <br /> <br />CONTRACTOR, <br />LICENSE NO: <br />BARLO~, THOMAS <br />SAME <br /> <br />PHONE: 749-1782 <br /> <br /> ITEM <br />NANUFACTUREO HOME SERVICE/FEEDER <br />ELECTRICAL STATE SURCHARGE <br /> <br />PERMIT OR APPLICATION NO: 41165 <br /> <br /> SUPERVISING ELECTRICIAN/HUMBER <br /> <br />TOTAL ASSESSEO FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY AMOUNT <br /> 1 $40.00 <br /> $2.00 <br /> <br />$42.00 <br /> $0.00 <br />$42.00 <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE: 8ARLOW, THOMAS RECEIPT MO: 43204 <br />RECEIVED BY: CL <br /> <br />TYPE: CA CHECK <br /> <br />* THIS I$ A VALID PERMIT · THIS PERMIT EXPIRES 180 DAYS FROM ITS iSSUE DATE. IF <br />CONSTRUCTION CEASES FOR A PERIOD OF LBO DAYS, OR IF CONSTRUCTION FAILS TO MEET ALL <br />REQUIREMENTS OF STATE LAWS AND MARION COUNTY BUILDING AND ZONING ORDINANCES, THIS PERMIT <br />SHALL BECOME NULL AND VOID. <br /> <br />REMARKS: 200 AMP S/C <br /> <br />DONALD E. WOODLEY, MARION COUNTY BUILDING OFFICIAL / BY <br /> <br /> OFFICE COPY <br />FORM # MC 15-56 REV. 4/90 <br /> <br /> <br />