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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 />of a registered builder. <br /> <br /> have read and agree to the terms stated on the reverse side of <br /> <br />2811 LYNA fie <br />': " SITE NUMBER: 95-BJi{~88 <br />,AI,,,[,N, (tlr 97;~83 <br />PHONE= 375-6296 <br /> L <br /> VALUATION: <br /> <br /> .... ................. <br /> <br />TYPE= ELECTRICAL <br /> <br />C O,~?R.A,& FOR,~ dO. 67091 <br />LILEIISE NO: <br />William D Ellrens <br />1&90 Laurel Ave <br />Woodburn, 97071-Me~M <br /> <br />PERMIT OR APPLICATION NO: 686~3~ <br /> <br /> SUPERVISIN6 ELECTRICIAN/NUMRER <br /> <br /> '[TEN : ]:::, QUAI,FF ]:T'y <br /> MANUFACTURED HOME SERV [:CE/FEE,DE:~ : :::: 1 <br /> ELECTR:[£~L STATE SURCHAREE:,]:i.,,,,: :: .... <br /> D EEs <br /> : <br /> <br /> PAYEE~ Willi~m g Ehrens ' : RECEIPT NO: <br /> RECEIVE~ BY: ~B '.OK CHECK <br /> <br />CONSTRUCTION CEASES FOR <br />REQU~EEHENTS OF STATE LA~$ ZONING <br />SHALL ~ECOME NULL AHD VO~. <br /> <br /> J ~.Hh;Ix,,. HS SERV <br /> <br /> AMOUNT <br /> $40,00 <br /> <br /> $42..08 <br /> $0.00 <br /> $42.00 <br /> <br /> $0,,00 <br /> <br />6~230 <br />3~16 <br /> <br />ISSUE DATE. IF <br />;LS TO NEET ALL <br /> , THIS PERMIT <br /> <br />DONAI.,.)') Ii!:,, WOODLI,_.'.Y, MARION COUN'Y'Y BUI;L:,D]'NG, OFF![CIAL / BY <br /> <br /> OFFDCE COPY <br />FORM # MC 15-5~ REV. 4/90 <br /> <br /> <br />