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MARION COUNT~,~"~ILDING INSPECTION <br />SENAT(-,i~CJLDG. NO, 225 <br />220 Jz~l/~,H STREET NE <br /> SALE' ~", ORLCGO N 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 P.M. - 8:00 A.M. <br /> <br />I am performing work Dna ropertylownoroc0upy. <br />lamaregtsteredbuilderOk( ) the authorized representative <br />of ~ registered builder, <br />The work will be performed by a registered builder. <br />Other, <br /> <br /> I have read and agree to the terms stated on the reverse side of <br /> this document. <br /> <br />DATE.+ 01/10~90 ~ TINE: 9..40:0~ <br />OWNER: <br /> PULL 60SPEL TABE~NACLE <br /> <br />SIGNATURE OF APPLICANT; <br /> <br /> DATE: <br /> <br /> TA~ LO'C: <br /> <br /> 10153 NILL CREEK RD SE C0~t~bt C~V: , UGh: <br />AUNSVILLE OR 9?325 <br /> <br />MARLING ADDRESS: <br /> <br />SO~Divi§~b~; <br /> NHITE ROCK ADDN <br /> <br /> SITE NUMBER: 9045 <br />.PHONE: 749-1279 " VALUATION: <br /> <br /> LOT: BLOC~: i SECTION: iTOWNSN~Pi RANGE: ZONE; <br /> <br /> 4 2 31 88 <br /> W~DTH: :~EC~TH: AREA: UNITS'. IRREG. LOT; : CORNER: <br /> : 1 . 50999999 AC YES NO <br /> <br />CATEGORY: <br /> RESIDENTIAL <br />OCCUPANCY: <br /> <br />OCCUPANT LOAD: <br /> <br />MAP: <br /> <br /> 48 <br /> <br />TYPE.' ELECTRICAL <br /> <br />CONTRACTOR, NO. 20098 <br />LICENSE :NO: <br />TEOO ELECTRIC <br />P.O. COX 671 <br />SAL~t, OREGON 97308 <br />PHONE: 370~7747 <br /> <br />PER/~IT OR APPLICATION NOt 21205 <br /> <br /> SUPERVISING ELECTRICIAN/NUMBER <br /> R. STE~NSROOK <br /> <br />NOeILE HOME SPACE (SVC E(~JIp) <br />ME~LE HOME CONNECTION <br />FLEET SURCHARGE -ZONE 3 <br />ELECTRICAL STATE SUROHAR6E <br /> <br />PAYEE= TECO ELECTRIC <br /> <br />QUANTITY AMOUNT <br />1 $25.00 <br />1 $25.00 <br /> $3.84 <br /> $2.50 <br /> <br />TOTAL A~.mSEE~EDFEES <br />PREVIOUSRECEIPTS <br />THIS RECEIPT <br /> <br />$58.34 <br /> $o.o0 <br />$55.34 <br /> <br />BALANCE DUE $0, O0 <br /> <br /> 2~499 <br /> RECEIVED BY: ¢] ,- TYPE: CK CHECK ~t: 5999 <br /> <br />~ THI~ I~ A VALID PIE~I~F · ~:~IT ,~I~. 180 ~ :~, i~ i~E ~ IF <br />~[~ ~ ~ A ~.~:.1,80 :~, ~ IFEIB FAI~ TO ~ Ab <br />~~~ ~ATE~D ~ID~ ~'~ ~D Z~l~ ORDi~, ~IS ~IT <br /> <br />RECEIPT NO= <br /> <br />REMARKS; f~H CON & SERV 1~0084 <br /> <br />DONALD E. HOODLEY. NARION COUNTY BUILDING OFFICIAL / BY ....... ~(~ <br /> <br />OFFICE COPY <br /> <br /> <br />