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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG NO 22,5 <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 />Other_ <br /> <br />OA~E: 0'¢/01/91 Ilf~Ea 11:42:05 <br /> <br /> O~IROiI .STAI~ RARK <br /> <br />SIGNATURE OF APPLICANT <br /> DATE <br /> <br /> TAX LOT <br /> <br /> CONSTRUCTION lYRE <br /> <br />CO¢4ML' RC i AL <br /> <br /> 4'? MiLE POST. NO 5ANII&M HWY <br />ROI I /JR 97342 <br /> <br />CONTRACT CITY LJOD <br />IVI.AR I ON COUNTY NO <br /> <br />OCCUPANT LOAD <br /> <br />MAILING ADDRESS <br /> <br />:40024 ~ILVkR PALLS HNY SE <br />"':.'U8 L [ M I fY OR 9'/385 <br />9H(.)NE: <br /> <br />lOT BLOCK SECTION <br /> <br /> TOWNSHIP <br /> <br /> LJNIT~ <br />104. <br /> <br />10 <br /> <br />AC <br /> <br />5tIE N'df'4WER: ,5943 <br />VALUA F ION t <br /> <br /> 5E <br /> NO NJ,) <br /> <br />TYRE: ELECTRICAL RERI"4II OR APRL[CAIION NO: <br /> <br />33332 <br /> <br />C(JN l RAC fOR, N(,). <br />LICENSE NO: <br />5PARKY ELECTRIC <br />Fb3'¢' LAKE;~iDb DRIV~ N~ <br />SALEM, OR 97305 <br />PMONL": 393-2604 <br /> <br />SUPERVISING ELEC f RiCIAN/NUMWEN <br />0UAN~ VAUB~,L 'B2540S <br /> <br /> 1 f EM <br />PJ RANCH CI~CU115 ONE <br />ELL'CT RICAL ~:~ IA I k 5UR(JIdAR(¢~ <br /> <br />QUANTIIY AMOUNf <br /> $1-¢b <br /> <br />TOTAL ASSg35ED PE~ <br />~REViOUS RECglPT5 <br />THiS RECEIPT <br /> <br /> BALANCE DUg <br /> <br /> RAYEk. ~PARKY ELECTRIC CO, RECEiP] NO: 35]50 <br /> RECEIVED BY: Ct_ IYPB: CK CHECK ~: <br /> <br />~ [HiS 15 A VALID PEh~lll' ~ THIS PERi'lIT [9(PIRES lBO DAYS FRO~I iTS iSSUE DATE. <br />CONSTRUCTION CEASES EOR A PERIOD OF 180 DAYS, OR IF CONSTRUCIION FALLS TO ~EET ALL <br />R~QUIREI~kNTS OP STATE L.~ AND I~RiON COUNTY 8UILDING AND ZONING ORDINANCES, THIS PER~iI <br />SHALL DEC(~ NULL AND VOID. <br /> <br />t,<bNARKS: I/.;tR POR GAS 9U~IP ~ CU~BL~ CK -LAKESIDE OP HNY 22 AT TU~L_~ <br /> <br />DONAL~ E. WOODLEY, ~ARiON COUNTY BUILDING OFT;ICIAL / BY ~ <br /> <br />=ORM # MC ~5-56 r~EV 4'90 OFFICE COPY <br /> <br /> <br />