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220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 P.M. - 8:00 A.M. <br /> <br /> J am performing work CA 8 gr'operty I own er occupy. <br /> lam a registered builder OR( )theautkorlzedrepresentative <br /> <br /> DATE: 10/']?/88 TIME: 11=25.'348 <br />~WNER; HAC4pTON, LAURENCE S & JACQUALIN S <br /> <br /> 10984 JA~4ES WAY SE <br /> AUMSVI LLE OR 97325 <br /> <br />SA~4E <br /> <br />PHONE: N/P <br /> <br />13 <br /> <br /> CONTRACT CITY'. UGB: ~OCCUPANT LOAL3: <br /> ~ARION COUNTY NO i <br /> Ir JO <br /> <br /> CAMELLIA HEIGHTS <br /> <br /> SITE NUNBER: 5615 <br /> VALUAT <br /> ION <br /> <br />29 8S ~ 1W I : <br /> <br />TYPE: ELECTRICAL PER24tT OR APPLICATION NO: 11497 <br /> <br />CONTRACTOR, NO. <br />LICENSE NO: <br />HAHPTON, LAURENCE S & JACQUALIN <br />SAME <br /> <br />SUPERVISING ELECTRICIAN/NUMBER <br /> <br />PHONE: N/P <br /> <br /> ITENI <br />MOBILE HONE SPACE (SVC EQUIP) <br />IviOBILE HONE CONNECTION <br />FLEET SURCHARGE -ZONE 2 <br />ELECTRICAL STATE SUR%HARGE <br /> <br />QUANTITY ANOUNT <br />1 $20.00 <br />1 $20.00 <br /> ~2.56 <br /> 2.00 <br /> <br />TOTALASSE~SED FEES <br />PREVIOUS RECEIPTS. <br />THIS RECEIpT <br /> <br />$44.56 <br /> 44.56 <br /> $0.oo <br /> <br />9ALANCE DUE $0.00 <br /> <br />PAYEE: RECEIPT NO: <br />RECEIVED BY: PS TYPE: CHECK ~: <br /> <br />~< THIS IS A VALID PERMIT ;~< THIS PERMIT EXPIRES 180: BAYS FROM.~ITS ISSUE DATE. IF <br />CONSTRUCTION CEASES FOR A PERIOD OF 180 BAYS, OR.. IF'.CONSTBUCT~ON FAILS TO MEET ALL <br />REQUIREMENTS OF STATE ~ AND MARION COUNTY BUILDING AND;,iZON~NG ORDINANCES. THIS PERMIT <br />SHALL 8ECO~IE NULL AND VOID. <br /> <br />REIV~ARKS: SERV/CONN ~=snso <br /> <br />DONALD E. WOODLEY, MAR~ON COUNTY BUILDIN~'OFFI. C-IAL /!'BY <br /> <br />OFFICE COPY <br /> <br /> <br />