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MARION COUNTY,,~UILDING INSPECTION <br />SENATOR BLDG.. NO.. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4::30 PM.. - 8::00 AM <br /> <br />I am performing work on a property I own or occupy <br />I am a registered builder OR I ) the authorized representative <br /> <br />The work will be performed by a registered builder <br />Other <br /> <br />DATE: 04/25/89 TINE.' 1:58:29p <br /> <br /> LANKFORD. BO8 R. <br /> <br />SIGNATURE OF APPLICANT <br /> <br />TAX LOT <br /> <br />CONSTRUCTION TYPE <br /> <br />RES I DENT I AL <br /> <br /> 11692 WARBLER LANE NE <br />AURORA OR 97002 <br /> <br />USE OF BUILDING <br /> <br /> CONTRACT CITY U¢~B <br />MARION COUNTY NO <br /> <br />OOCUPANTLOAD <br /> <br />6645 SN NYBERG RD <br />TUALATIN, OR <br />PHONE: 692-5513 <br /> <br />LOT SL,OOS SF. CTION TOWNSHIP <br /> 10 19 33 <br /> <br />SUBDIVISION <br /> <br />CENTURY HEABONS PHASE 4 <br /> <br />3S <br /> <br />SITE NUMBER: 7069 <br />VALUAT I ON: <br />RANGE ZONE MAP <br /> <br /> 1N AR t <br />IRREG LOT CORNER <br /> NO NO <br /> <br />TYPE: ELECTRICAL <br /> <br /> CONTRACTOR, NO. 35151 <br /> LICENSE NO: <br />PARKIN ELECTRIC INC <br />,RT 5 BOX 79-K <br />SHERNOOD 97140 <br /> PHONE: 246-1301 <br /> <br />PERMIT OR APPLICATION NO: 9015439 <br /> <br /> SUPERVISING ELECTRICIAN/NUMBER <br /> 898-S <br /> <br /> ITEM <br />MOBILE HONE SPACE (SVC EQUIP) <br />MOBILE HOME CONNECTION <br />FLEET SURCHARGE -ZONE 6 <br />ELECTRICAL STATE SURCHARGE <br /> <br />PAYEE: ADNI.RAL Ivlq~-dj~ HOMES <br />RECEIVED BY. PR ~[ I~ , <br /> <br />QUANTITY <br /> 1 <br /> 1 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS:, <br />THIS RECEIPT <br /> <br />AMOUNT <br /> 525.00 <br /> 25.00 <br /> <br /> $2.50 <br /> <br />$60.18 <br /> $0.00 <br />$80.18 <br /> <br />BALANCE DUE $0+00 <br /> <br />,RECEIPT NO: 18395 <br />TYPE: CK CHECK ~: 1494 <br /> <br />~< THIS IS NOT A PERMIT. THIS APPLICATION f4UST 60:THROUG'.-I A REVIEH PR~X;E~ ~HERE THE <br />FOLLOI~INS Dt~T BE (~PLETED. : IT IS THE RE~P~ISILI~Y OF THE APPLICANT TO A~RE THAT <br />ALL NECESSARY INFOI~TION HAS BEE~ PROVIDED. <br /> <br />PLAN REVIEI~: BY DATE <br /> <br />RFJMARKS: IVlH SERV & CONN R~7316 <br /> <br />CITY JURISDICTION= BY ......... DATE ......... <br /> <br />FORM ~ MC15-56 RE9 II'"~ OFFIC~ COPY <br /> <br /> <br />