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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 5,8.¢-5147 <br />CODE-A-PHON,E 4:30 P.M, - 8;00 A,M. <br /> <br />05/20/8(3 ",riME: <br /> <br />;v~,[S ~ C, PATR'fCiA <br /> <br />SIGNATURe OF APPLICANT: <br /> <br /> 5721 VILLAGE VI~-~ CT SE :~0NT~ACT CITY: : UGB: iOOCUPAN'F LOAD: <br />.a,UMC. SV ILL E OR 97325 ~ <br /> ........ I~AR~ ~ C~NTY NO <br /> <br />2 <br /> <br />VZ LLgGE VIEI~ <br /> <br /> SITE NUMBER: 45?4 <br /> VALUATION: <br /> <br /> !3 SS 2N ! AR3 49 <br />AREA; UNITS: I~, LOT: CORNER: <br /> <br />TYPE: ELECTRICAL <br /> <br />CQNTRACTOR ~ NO., <br />LICENSE NO: <br /> 4U;:,IC ~ PA'TR [CIA <br />SAME <br /> <br />PHONE: <br /> <br />PERNIT OR APPLICATION NO: 83?3 <br /> <br /> SUPERVISING ELECTRICLAN/NUN~B6R <br /> <br />TOTAL ASSE.~.SED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY A~,OUNT <br /> i $20.00 <br /> $3.84 <br /> $ 'i, oD <br /> <br />24.84 <br />SO.Sc <br /> <br /> iTEM <br />,~4OSILE HOME CONNECTION <br />PLEET ,SURCHARGE -ZONE 3 <br />ELECTRICAL_ STATE SURCHARGE <br /> <br />BALANCE DUE <br /> <br />RECEIPT NO: <br /> <br />PAYEE: <br />RECEIVED BY: pb ................................ TYPE: CHECK ~: <br /> <br />a T~IS IS A VALID PER~4IT ~ THIS 9ER~IT EXPIRI-~ lB0 DAYS ~RO~ ITS I~E ~TE. IF <br />~TI~ O~ FOR A PERIOD OF 180 OA~ OR IF ~T~CTI~ FAI~ TO ~ ALL <br />RE~IR~TS OF STAT6 ~ ~D ~ ~N~ BUILDING ~DZ~IN60RDI~O~, ~IS PE~T <br />~ALL 8E~B NULL ~D VOID. <br /> <br />RE!iARKS: CONN R~9997 <br />DONALD E, WOOOLEY. i~ARION COUNTY ~UZLDZNG OFFICIAL / BY .................. ~ .................... <br /> <br />~O~M ,, MC ~,~-!~e R~'V 6~,~ OFFICE COPY <br /> <br /> <br />