|
MARION COUNTY BUILDING INSPECTION
<br />SENATOR BLDG. NO. 225
<br />220 HIGH STREET NE
<br /> SALEM OREGO? 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 breperty I own or occupy.
<br />I am a registered builder OR the authorized rebresentative
<br />of a registered builder,
<br />The work wil~ be performed by a registered builder.
<br />Other,
<br />
<br />I have re~d and agree to the terms staled on the reverse side of
<br />this document,
<br />
<br />'OWNER:i)A'¥'?: 'L2'/~"'q'/V:~ ~'/-~ '/ ~ ~ ..... ; f~LOY1 ]'~f~N?:
<br /> ~,,,,,,~ k~,~, ,.I.,,d,,¢ ~ ,. ,,, E ~,.,,-~,¢.1. I RES;J:DENT:~;AL
<br />
<br /> 7492 LOFTY LOS;;' SE CONTRACT CITY: ~ UGB: OCCUPANT LOAD;
<br />
<br /> //;:.!!.~J 6',".F!'H A
<br /> PH3NE: ~r~),,, 544,~; VAL.UA'F~ON~
<br />LOT: ri BLOCK'. i SECTION;
<br />
<br /> ~, ~ ....... ~ ........................ x ...... ~, , ....................... & ...... ~.,.,.~ ,~ ~ ~,¢.~. ~.~_.~_~ .................... ,...... ~ ~., ~.~ .............
<br />
<br />TYPE: ELECTRTCAL
<br />CX:I N ',"' 5: A C-;' 0 F~., NO,, 04259
<br />Riches E1,,%;tric Co
<br />
<br />F -,0{,: 56 ~""4:1, 56
<br />
<br />~;:,,..~:;(;]"i:;',IC~.., STATE SURC;Fi&R(~E
<br />
<br />PERHIT ~R APPL'rCAT'FOH N~:
<br />
<br /> SLPERVISi;N(; .LEC ,,..LLAil/14b
<br />
<br />&~U A N"F I T Y A M ()U N'f'
<br /> $2., ,90
<br />
<br /> TOTAl: ASSESSED FEES $4~,.
<br /> PRFVlOUS RECE IF"¥S: ~;~,l
<br /> : ': THZS' RECEIPI- $42
<br />
<br /> PAYEE',: K.ix,,;.6,~ IE3. ec'~'r~c gO' ~:':: RISC;El:PT NO: ,., ,49o
<br /> ,O,{J:..,VED BY: DK2 ............ _.__:: .................... ~., ..... TYRE. CK (.4EE,t :~: 5~89
<br /> · THZS ~S ~ VALZD PERM;zT:* THZS :FROM ZTS ZSSUS D~TS. ZF
<br />CONSTRUCTION CEASES Fg~ :A PERIDD:OF,~[88 :DAYS; RR IF CONSTRUCTION FAILS TO MEET ALL
<br />SHALL BECOME NULL AND VOID;
<br />
<br /> H o- - - F v
<br /> REHARKS: iH ,:~ERVICc _]NL,
<br />
<br /> Ob~lAl.,~* E,, KOODLEY,; ~A~D',ON COUNTY BUZLD~N~ OFF:J;C]',AL / BY __~__~
<br />
<br />~D.u # uc ~.s~ Re.,, 4~ OFFICE COPY
<br />
<br />
<br />
|