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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 perforc/iftg work on a property I own or OCCUpy. <br /> lar~aregistered builderOR( )theavtnorizedrepresentative <br /> of a registered builder. <br /> T~e work will be performed by a registered builder. <br /> Other~,. <br /> I have read and agree to the terms stated on the reverse side of <br /> this document. <br /> <br /> DATE: 11/14/90 T I~IE: 9: 50*. 09 <br /> <br />OWNER: <br /> KLEIN, LARRY <br /> <br />S~TUS ADDRESS; <br /> <br /> 9804 FIlLL CREEK RD SE <br />AUfvlrSVi LLE OR 97325 <br /> <br />MAILING ADDRESS: <br /> <br />IVl~R I ON COON'f'Y <br /> <br />SUBOIVI31ON: <br /> <br /> :UGB: <br /> <br /> NO <br /> <br />F:LOODPLA~N <br /> <br /> 749-2405 <br /> <br /> LOT: SLOCK; : sEC~IoN~ TOWNSH <br /> 31 <br /> <br />WIDTH: :D~PT.: A"~ i3. UNITS: <br /> <br /> SITE NUtW~ER: <br /> VALUA'TION= <br /> <br />8S 1~ <br />AC NO <br /> <br />5084 <br /> <br />ZONE: <br /> EFU I 49 ~ <br /> <br />TYPE= ELECTRICAL <br /> <br />C~I~'I'RAOI'OR, NO. 3964 <br />LICENSE NO: <br />JACK'S ELECTRIC <br />10764 ~ILL CREEK RD <br />AUtWSVILLE 97325 <br />PHONE= 749-2971 <br /> <br />PERMI'r OR APPLICATION NO: 28707 <br /> <br /> .SUPERVISING EL~'f Ri C i AN/c'NUI',IB ER <br /> JOHN A. SPEER,/lO995 <br /> <br /> iTEM <br />BRANCH CIRCtJtTS - 'f'lt¢3 TO 'FEN <br />ELECTRICAL STATE SURO,'HAREE <br /> <br />PAYEE: JACK'S ELE'~'rRiC <br /> <br />TOTAL ASS~EO ffEB.~ <br />PREVIOUS RECEIPTS <br />'FHiS RECEIPT <br /> <br />(JUANTITY Af4OUN1' <br /> I $50.00 <br /> $2.50 <br /> <br />$52.50 <br /> <br />$52.50 <br /> <br />BALANCE DUE $0.00 <br /> <br />RECEIPT NO: <br /> <br /> 30332 <br /> RECEIVEO BY: DIV12 I'YPE~ CK CHECK ~: 1885 <br /> <br />x~ THiS IS A VALID PERMIT * THIS PER,lIT EXPIRE~ 18o 0AYS FRO~I ITS lEagUE DATE. <br />CONSTRUCT/ON CEA~"s~ FOR A PERIOD OF 180 DAYS, OR IF CONSTRUCT[ON FAll~ TO FLEET ALL <br />REQUIREFIEIflT~ OF STATE LAB~ AND FIARION COUNTY BUILDING AND ZONING ORDINANCES, THIS PERMIT <br />SHALL BECOME NULL AND <br /> <br />RE~ARK~: 2-10 CiR 1~,4G03 <br /> <br />DONALD E. WOODLEY, ~RICN COUNTY BUILDING OFFICIAL / BY <br /> <br />PORM # MC ~S-~r~ REC. 4/90 OFFICE COPY <br /> <br /> <br />