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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97'301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />of 8 registered builder, <br /> <br />SIGNATURE OF APPLICANT: <br /> <br /> DATE: <br /> <br />OWNER: <br /> CLARK, NAR'r IN <br /> <br />~2:28:19 <br /> <br /> 20521 BOONE.,~ FERRY RD NE <br />AURORA OR <br /> <br /> CONTRACT C~TY <br /> <br />'v~AR,[ ON CtTJN'f'Y <br /> <br />UGB <br /> <br />MAILING ACCRESS: --~ <br /> <br />P.O. BOX 168 <br />AURORA, OREGON 97002 <br />PHONE: 678-1139 <br /> <br />LO'~ BLOCK; SECTION TOWNSHIP <br /> <br />~I 'l'E NUI~4f¢ ER ~ <br /> VALUATION: <br /> <br />NO <br /> <br />N(.] <br /> <br />CATEGORY' <br /> RES i D~N i' i AL. <br />OOCUPANCY: <br /> <br />OOCUPAN~ LOAD. <br /> <br />NO <br /> <br />TYPE: ELEC'rRICAL PERMIT OR APPLICATION NO: <br /> <br />27534 <br /> <br />CONTRACTOR, NO. <br />L i C.~NSE NO: <br />CLARK, MAR'I' IN <br />P.O. BOX 168 <br />AU R'ORA, ORE(~'ON <br />PHi)NE: 698-I]39 <br /> <br />%U PERV i,~,i NG ELECTRICIAN/NUIWg, ER <br /> <br /> iTEM <br />SERV[CE/F~EEOER 101 TO 400 AMPS <br />ELECI'RICAL STATE SURCHARGE <br /> <br />QUANTITY AMOUNT <br /> ] $60.00 <br /> <br /> TOTAL~ESSEO FEES <br />PREYJOUS RECEIPTS <br />THIS RECE[P'f' <br /> <br />63.00 <br />$o.oo <br /> <br />8ALANCB DUE <br /> <br /> PAYEE: RECEIPT NO: <br /> RECEIVED BY: P8 ........................................................................................................ TYPE: O~ECI~ ~: 0 <br /> <br />* THiS iS A VALID PERfflIT ~ THI~ PERMIT EXPIRES; 180 BAY8 FRO~I ITS i~E DATE. iF <br />~s'r~c'rl~ C~ FOR A PERIOD OF 180 ~, OR IF~ST~CTI~ FAi~ TO ~EET ALL <br />RE~iR~TS OF STATE ~ ~D ~Ri~ ~NTY BUILDING ~D Z~iNG ORDiN~C~, THIS PER, iT <br />~L 8EC~E NULL ~O rOlO. <br /> <br />REI~ARK$: RELOCATE SERV ~ INCLUOE~ CIRCUITS FOR C&ARAf,~E <br />DONALD E. WOOOLEY, MARION COUNTY BUILDING OFFiCiAL / BY <br /> <br />OFFICE COPY <br /> <br /> <br />