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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEI~.., OREGON 97301 <br /> <br /> PHONE .'-688-514'7 <br /> CODE-A-PHONE 4:30 P,M. - 8;00 A.M. <br /> <br />I gte performing work On a property f OWn Or O¢0UDy. <br />lam a registeredbuilPerOR( ) the authorized representative <br />of a registered builder, <br />The work will be performed by a registered builder. <br />Other ....... <br />I have read and ~gree to the terms stated on the reverse side of <br /> <br />ANDERE~, TON <br /> <br />T~X LOT: <br /> <br />CONSTRUCTION TYPE: <br /> <br />CATEGORY: <br /> <br /> RE$I DENT ] AL <br /> <br /> 11599 ~LELL. AN LANE SE <br />AUD'ESVILLE OR 97325 <br /> <br /> ~T RACT CITY: <br />NARION COUNTY <br /> <br />OCCUPANT LOAD: <br /> <br /> NO 0F BEDROOMS: <br /> <br />]PO 8OX 53 <br />iNEST STAYTON 97328 <br />PHONE: 769-3823 <br /> <br /> SITE NU,h~BERt 9238 <br /> i VALUATION <br />TOWNSN~P; RANGE; ZONE~ <br /> <br />NO NO <br /> <br />TYPE: ELECTRICAL <br /> <br />CONTRACTOR; NO. <br />LICENSE NO. <br />ANDERSON, TOM <br />PO BOX 63 <br />~EST STAYTON 97325 <br />PHONE: 769~3823 <br /> <br />PERNIT OR APPLICATION NO: 21354 <br /> <br /> SUPERVISING ELECTRICIAN/NUMBER <br /> <br /> ITEM <br />SERV CHANGE ONLY-ED(ISTING RESIDENCE <br />FLEET S~RCHARGE -7ONE 3 <br />ELECTRICAL STATE SURCHARGE <br /> <br />PAYEE: ANOERSON, TON <br />RECEIVED BY: OH <br /> <br /> (~JANTITY AMOUNT <br /> 1 $30,00 <br /> $3,84 <br /> $1,50 <br /> <br /> $35.34 <br /> $o.0o <br /> $35,3¢ <br /> <br />RECEIPT NOt 22859 <br /> <br />TOTALAE~ESSED FEES <br />PREVIOUSRECEIPTS <br />THIS RECEIPT <br />BALANCE DUE <br /> <br /> * lltJ8 IS A VALID PE~IT '*: ~IS PE~IT EXPIRES 180 DAYS FROM ITS IS,.'~E DATE. IF <br />CONSTRUCTION CEA~ FOR A PERIOD OF 100 DAY~. OR IF CONSTRUCTION FAIL~ TO MEET ALL <br />RL=QUIREI~TS OF ~TATE ~L~ID.AND I~IARION COUNTY ~UILDING AND ZONING ORDINANCES, THIS PERMIT <br />SHALL BECOME NULL AND <br /> <br />REMARKSt SERVCHGE R~2610 <br /> <br />DONALD E. NOODLEY, MARION COUNTY BUILDING OFFICIAL / DY <br /> <br />OFFICE COPY <br /> <br /> <br />