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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, 225 <br />220 HIGH STREET NE <br /> S~_ LEM,~3REGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 P.M, - 8;00 A.M, <br /> <br />TAX LO~J i cATEGoRY: <br /> <br />RESIDENTIAL <br /> <br /> 10955 MIX RD SE <br />AUMSVILLE OR 97325 <br /> <br /> CONTR~I~Y: ¢'~'6~ !OCCUPANT LOADL <br />MARION COUNTY <br /> <br /> SAME <br /> <br /> PHC)NEt 749~1354 <br /> <br />LOt: iU~0~K: 'i~'¢¥i6Ni TOWNSP <br /> 20.0000 <br /> <br /> SITE NUNBER: 5515 <br /> VALUATION: <br /> <br /> RANG5~ ; ZONE; ; MAP; <br />9S 1~ i EFU r 60 <br /> <br />AC tRREG. LOT; NO i <br /> <br />TYPE= ELECTRICAL <br /> <br />CONTRACTOR. NO, <br />LICENSE NO: <br />MIX, FRANCIS A. <br />S~4E <br /> <br />PHONE: 749-'1354 <br /> <br />PERMIT OR APPLICATION NO: 11343 <br /> <br /> ,~¢JPERVISING ELECTRICIAN/NU~FCBER <br /> <br /> ITEM QUANTITY A~OUNT <br />MOBILE HOME SPACE (SVC EQUIP) I $20.00 <br />MOelLE HOME CONNEC]~ION I $20.00 <br />FLEET ~RCHARGE -Z~E 3 $3.84 <br />ELECTRICAL STATE SURCHARGE $2.00 <br /> TOTAL ~E~' FE~ $45.84 <br /> PREVI~S RECEIPTS $45.84 <br /> THIS RECEI ~T $0_00 <br /> ~AL~CE ~E : · $0.00 <br /> <br />PAYEE: '~'; <br /> , ~ECEIPT NO: <br />~ECE[VED BY= P8 ~PE: CHECK ~: <br /> <br />~ ~IS IS A VALID PE~IT · ~IS ~';~TS ~E DATE. ~P <br />~T~CT~ C~ FOR A PER~O~: OF 180 ~, OR IF :~ST~O~ ~AI~ TO ~E~ ALL <br />RE~R~TS OF STATE ~ ~D ~R[~ ORDINal, ~IS PE~IT <br />~ALL 8E~E NULL ~B VOID. ' <br /> <br />REMARKS= MH SERV & CON R~4985 ' ~', <br /> ,,,:'? <br /> <br />DONALD E- ~OOLEY, ~ARION COUNTY 8 ILDING:OFFICIAB /=B~ <br /> <br /> <br />