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MARION'COUNTY BUILDING INSPECTION <br />SENATOR RLDG, NO, 225 <br />220,,.,HIGH ~-TREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br /> CODE-A-PHONE 4:30 PM. - 8:00 A,M, <br /> <br />[ am performing WOrK Or~ a.~roperty I own or occupy. ~;::~~ <br />I ar'fl a registered b(~ilder Ol~ ( ) the authorized represer~tative SIGNAIrURE OF APPLICANT: <br />of a registered builder. <br />The work will be performed by a registered builder. <br />Other .... <br />J hSVe read and agree to the terms stated on the reverse side of ~A'~'E: <br />this document. <br /> <br />CATE: 08/29/89 TIME: 9: 07: 3'1,~ <br /> <br /> ADAIR, R I CI"I,A,R[; 56272-000 <br /> <br />9823 MILL CREEK RI'-'~ SE <br />]vl,~ V I :.L. E OR 97325 <br /> <br />USE OF BUILDINGI <br /> <br />CONTRACT CITY; UGB: <br />IVC, R ION COUNTY 1'40 <br /> <br />OCCUPANT LOAD: <br /> <br /> NO OF SEC)ROOMS <br /> <br />MAILING ADDRESC): SUBDIVISION: <br /> <br /> /~,UMSVI: LLE, OR <br /> PHONE: "?a.<~-.-299'1 ~ .C--1.~/. <br />LOT; BLOCK: SECTION: <br /> <br />WIDTH: DEPTH: AREA: <br /> <br /> VALUATION: <br /> <br /> 30 95 '1~ SA <br />5.50000 AC NO NO <br /> <br />MAP: <br /> <br />4~ <br /> <br />TYPE: ELECTRICAL PERMIT OR APPLZCATION NO; 90]8496 <br /> <br />CONTRAC]'OR, NO. <br />L.:CENSE NO: <br />ADAIR, RICHARD <br />9363 MILL CREEK RD SE <br />AUMSVILLE, OR <br />P!"!ONE: 749-..299'i <br /> <br />SUPERVISING ELECTRICIAN/NL, fvlSER <br /> <br /> ITEM <br />MO~?IL_E HOIV~E CONNECTION <br />;:L, EET SURCHARGE -~ZOi',IE 3 <br />ELECTRTCAL ,S]"ATE 5URCPIARGE <br /> <br />QUANT I TY AMOLIN T <br /> <br />P.AYEE~ ADAIR, RICHARD <br />F~.£CE i VED .[':IY: <br /> <br />TOTAL ASSESSED PE~,-,S $30,0~? <br />PREVIOUS RECEIPTS ~,0.C2 <br />THIS RECEIPT $'~ <br /> <br />8AL.AN(]E DUE SO.SC <br /> <br /> RECEIPT N(}: 19622 <br /> ~rYPE:, CK CHECK ~: 324.2 <br /> <br />~ THIS IS NOT A PERfviIT ~HI~A~PEZCATION :I~LJ~T GO ~RQ61~':t'~ ~m,/f~W pp¢,¢,~ ~p ~m <br />FOLL~ING ~ST BE ~PLE~ED~:,,,,%,;I~C)~IS~,~E ',R~S~BIE,~'OF,,THE APPLIC~T TO ~RE THAT <br />ALL NEC~ARY INFO~TI~ H~,~BE~~VIDED. <br /> <br />~O.M ~ MC ~-~6 ~v ewe8 OFF[CE COPY <br /> <br /> <br />