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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG. NO, <br /> 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 />Other <br /> <br />I have read end agree to the terms stated on the reverse side of <br />this document. <br /> <br />SIGNATURE OF APPLICANT: <br /> <br /> DATE: <br /> <br />12/20/89 TIME: 15:59:25 <br /> <br />CATEGORY: <br /> <br />MIKE <br /> <br />CONSTRUCTION TYPE <br /> <br />OCCUPANcy:RES I DENT I AL <br /> <br /> ?63 E VII:~INIA ST <br />STAYTON OR 97283 <br /> <br /> CONTRACT CITY <br /> <br />STAYTON <br /> <br />UGS :OCCUPANT LOAC' <br /> <br />SUBC VISION <br /> <br />PHONE.* 769-3406 <br /> LOT: : BLOCK: <br /> <br />SITE NUMBER: 9030 <br /> <br />WIDTH; DEPTH: <br /> <br />AREA' UNITS ~RREG LOT CORNEF <br /> <br />Nn ,, Nn <br /> <br />TYPE: ELECTRICAL <br /> <br />CONTRACTOR, NO. <br />LICENSE NOt <br />LACKNER, MIKE <br /> <br />PERNIT OR APPLICATION NO~ 20931 <br /> <br /> ¢¢5PERVISIN6 ELECTRICIAN/*NUMBER <br /> <br />PHONE: 769-3405 <br /> <br /> ITEM <br />SEEV CHANGE ONLY-EXISTING RESIDENCE <br />ELECTRICAL STATE SURCHARGE <br /> <br />PAYEE: LACKNER, MIKE <br />RECEIVED BY: OM <br /> <br />QUANTITY AMC~JNT <br /> 1 $30.00 <br /> $1.50 <br /> <br />TOTAL A.~ESSED FEES $31.50 <br />pREVIOUS RECEIPTS $0.00 <br />THIS RECEIPT $31.50 <br /> <br />BALANCE BDE $0+00 <br /> <br />RECEIPT NO: 22203 <br /> <br /> TYPE: CA CHECK ~: 0 <br /> <br />* THIS IS A VALID PEI~IT ~ THIS PEF~lITEXPIRES180DAYS FROM ITS ISSUE DATE+ IF <br />C~NSTRUCTION CEASES FOR A PERIOD OF 1BODAYS', OR IF CONSTRUCTION FAILS TO NEET ALL <br />P~B~JI~TS OF STATE LAW~ANDMARION COJNTYBU[LDIN~AND ZONING ORDINANCES, THiS PERMIT <br />SHALL 8ECODtE NULL AND VOID+ <br /> <br />REMARKS: sEEr CHGE RI~2555 <br /> <br />DONALD E, NOODLEY, MARION COUNTY BUILDING OFFICIAL / BY <br /> <br />OFFICE COPY <br /> <br /> <br />