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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am a refji~er~d builder OR ( ) the ~uthorized represer~tative SIGNATURE OF APPLICAN <br />OI a egistered builder, <br /> <br />ovf~t~E: 02/26/91 'TItlE; 14:42:00 <br />s.us ADDnE¢~HNs~' JIM <br /> <br />CONSTRUCTION ~'W~ ',¢3~50--O~J--8'7 OCCUP,~CV R£S;(~)EN7 iai. <br /> <br /> CONTRACT CITY tJGB <br />19872 OLJ'4~'f-EAro RD NE <br />AURORA OR .92002 .. <br />uSE OF BUILDING. I','!ARiON COUNTY NO <br /> <br />MAILING ADDRESS SUBC SION <br /> <br /> DAY 682-2420 <br /> P'Hr.~: 6'/8-51~:¢ 511'E NUIV~ER: 530 <br />LOt: ,BLOCK SECTION~ TOWN¢~'~ RAt~J~UA'~' ~ ON .' ~.O, NE MAP: <br /> <br />A~lEA 19 . '4~TS 4~ RREG LO~ 1 [~ CORNER EF;:U <br /> 7'1 ~.~ ~r~ NO ' NO ' <br /> <br />'TYPE: ELEC'I RICAL <br /> <br />L.%)Nr RAC'f'OR, NO. <br />L .L CENSE NO: <br />JOHN~)N. J I~ <br />S.~d'eE <br /> DAY 682-2.4780 <br />PHONE: 578-5133 <br /> <br />PEklVlll' OR APPLICAI'iON NO: 90,30629 <br /> <br /> ~UPERVISING ELEC'f'R I C 1AN/NUI',~ ER <br /> <br /> iI'E~ <br />r4ANUFACTUREO HOIvIE SERVlCE/P'EEOER <br />ELECTRICAL STATE 21~URCHARI~E <br /> <br />QUANt'iIY ANIOUNT <br /> ~ $35.00 <br /> $t.75 <br /> <br /> TOTAL AS,SEcSSED ,cE~ $36.75 <br /> PREVIOUS RECEIPI'$ $0- 00 <br /> THIS REC~iP'f' $38.75 <br /> <br /> BALANCE DUE $0.00 <br /> <br /> PAYEE: JOHNr~A}N, JiM RECEIPT NOt 32'356 <br /> RECEIVED BY*. ~ ....................................................... ;. ................................ I'YP'¢.:: CK CHECK ~: 339 <br /> <br />'~ THIS IS NOT A PEI~IT. THIS APPLICATION ~UST GO THR~IJ~I A R~IEla/ PROCES~ ~I-tERE THE <br />FOLLO~iN~ r4JsT RE COMPLETED. iT I~ THE RESPONSIBiLiTY OF THE APPLICANT TO ~RE THAT <br />ALL NEClE~:~ARY [NI;Ot~IAT[ON HAS BEEN PROVtOEO. <br /> <br />PLAN REVIEW: BY .................................... DATE ..................................... CII'Y JURI~OiC'T'iON: BY ......................... DATE ................................ <br /> <br />R,~,"[ARKS: CONN R~5230 <br /> <br />FORM # MO 15-66 REV. 4/90 OF FICE COPY <br /> <br /> <br />