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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 a reoi~tered builder OR { ) the authorited representative SIONATURE OF APPLICANT'. <br />of a registered builder, <br /> <br /> The work WiN be performed by a registered builder, <br /> Other <br /> I have read And agree to the terms stated of~ the reverse side of <br /> this document. <br /> <br /> :0 A'rE.. 04/28/?)J <br />oWf~ER' <br /> BENTZ~ KEN <br />SIT~S ADD~ESS <br /> <br />TIME: t~:22:¥5 <br /> TAX LOT <br /> <br /> .............. 0ONSTRUOTION '~Y~' <br /> <br /> 5830 SHAW HWY SE <br />AHMSV IU._E OR '~7525 <br /> <br /> RESIDENTIAL : <br />'I'~O~S,~ANdY: <br /> <br />' ~6~:r'~,~6i' ~iTY~ ........ r <br /> MAR,ION COUNTY HI] <br /> <br />5828 SHAW NWY SE <br />AUN,'~V.[LLE. OE 973~,.,~ <br />PHONE: 3,'52-6353 <br /> <br />SUBDIVISION <br /> <br />SITE NUMBER: <br />VALUATION: <br /> <br />L~T: ''r BLOCK' ' SECTION <br />WIb'TN: ' DEPTH; AREA' <br /> <br />................ U~V~: ~ ............... ~REG LOT; .... 1~5~'; ........ <br />3.03 AC NO ] NO <br /> <br />TYPE; ELECTRICAL <br /> <br />CONTRACTOR~ NO,, 78229 <br />LICENSE NO: <br />X L ELECTRIC <br />50~ COPPER CREEl( L. OOP <br /> <br />PNOI,IE: 390-8482 <br /> <br />PERMIT OR APPLICATION NO: 4677~ <br /> <br /> ~RER <br /> SUPERVISING ELECTi;~ICIAN/Nt, r~, E' <br /> <br /> ITEM <br />MANL}FACTURED HOME SERVICE/FEEt)ER <br />BRANCH CIRCUI'f~ WITH SER¥ICE OR FEEDER <br />ELEGTRICAL STATE .)URCHARGE <br /> <br />PAYEE: X L ELECTRIC <br /> <br />TOTAl. ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY AMOUNT <br />1 $40.00 <br />1 <br /> <br />$44.10 <br /> $0.88 <br />$44.10 <br /> <br />BALANCE DUE $0.00 <br /> <br />RECEIPT NO: 4~019 <br /> <br /> RECEIVED BY: I)M2 ............................................. TYPE: CK CHECK ~: 979 <br /> <br /> $ TMIB ~B A VALID PER~IT ~ THIS PERMIT E×PIRE~ &Se DAYS FROM ITS ISSUE ~A~. IF <br />CONSTRUCTION CEASES FOR A PERIOD OF 18~ DAYS, OR IF CONSTRUCTION FAILS TO ~EET ALL <br />REQUIREMENTS OF STATE LAWS AND MARION COUNTY BUILDIN~ AND ZONING ORDINANCES, THIS PERMIT <br />SMALL BECOME NULL AND VOID. <br /> <br />REMARKS:: HH SERVICE &CtR FOR GARAGE I'~,% <br />DONALD E. WOODLEY,¢. MARION COONTY BUILDING OFFICIAL / BY .......................................... ..~. <br /> <br />FORM ~ MC 11~-~ REV. 4/90 0 F FICE COPY <br /> <br /> <br />