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SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br />SALEM, OREGON 97301 <br /> <br /> PHONE 688-5147 <br />CODE-A-PHONE 4:30 P.M. - 8:00 A.M. <br /> <br />I am performlnf work on a property I own or occupy. <br />I ~m a registered builder OR the authorized representatlve <br /> <br /> I huv~ read and ~gree to the terms stated on the reverse side of <br /> <br />DATE: 05/11/88 TIME: 2:10:31p <br /> <br /> N ICHOL, STb-~CEN <br /> <br />TAX LOT: CATEGORY; <br />CONSTRUCTION TYPE: : OCCUPANCY: <br /> <br />RESIDENTIAL <br /> <br /> 12164 W. STAYTON RD SE <br /> AUMSVILLE OR 97325 <br /> <br />USE OF BUILDING: <br /> <br />MAR YDN .COUNTY,, NO ; <br /> <br /> SAME <br /> <br /> PHONE: 769-2989 SITE NUMBER; 4394 <br /> VALUATION: <br />LOT: BLOCK: ~E~TION'. tOWNSHIP: F{ANFJE: ;ZONE: MAP: <br /> <br /> UNITS: ' IRReg. LOT: CORNERZ <br />2. 50000 AC NO NO <br /> <br />TYPE: ELECTRICAL <br /> <br />CONTRACTOR, NO. <br />LICENSE NO: <br />N ICHOL., STEVEN <br /> <br />PHONE: 769-2989 <br /> <br />PEK-~IT OR APPLICATION NO: 8423 <br /> <br /> SUPERVISING ELECTRICIAN/NUMBER <br /> <br /> ITFJ~ <br />SERV CHANGE ONLY-EXISTING RESIDENCE <br />FLEET SURCHARGE -ZONE 3 <br />ELECTRICAL STATE SURCHARGE <br /> <br />PAYEE: NICNOL, STEVEN <br /> <br />QUANTITY AMOUNT <br /> 1 $20.00 <br /> 3.84 <br /> 1.00 <br /> <br /> TOTAL 4SSE~ED FEES <br /> PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$24.84 <br /> $0.00 <br />$24+64 <br /> <br />BALANCE DUE $0.00 <br /> <br /> 9075 <br />RECEIVED 8Y: DM ............................ ._ .~_ TYPE~ CA CHECK ~¢: 0 <br /> <br />~ THIS IS A VALID PERMIT ~< THIS PEF~4IT EXPIR~.~ 18Q DAR FRON ITS IE~StJE DATE. IF <br />CCNSTRUCTION cEASES FOR A PERIOD OF 180 DAYS. OR IF CONSTRUCTION FAILS TO MEET ALL <br />REOOIR~ENTS OF STATE LANS AND MARION COUNTY BUILDING AND ZONING ORDINANCES, THIS PERNIT ; <br />SHALL BECOME NULL AND VOID. <br /> <br />RECEIPT NO: <br /> <br />RE:MARKS: SERV CHGE R~6020 <br /> <br />0ONALD E. NOODLEY, HARION COUNTY BUILDING OFFICIAL / BY <br /> <br />~OnM,, MC 5~ ~:v ~/~ OFFICE COPY <br /> <br /> <br />