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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 performing work on a property I own or occupy <br />I am a registered builder OR f he av horized represen <br /> of a registered budder, <br />The work will be performed by 8 registered builder <br />Other <br /> <br />DARE= 12/19/90 'rifflE: 15:11:50 <br /> N ICHOL, GLEN <br /> <br />SIGNATURE OF APPLICANT <br /> DATE <br /> <br /> TAX LO'i' <br /> 55565-008 <br /> CONSTRUCTION TYPE <br /> <br /> 8420 HOL~lqUIS'F RD SE <br />AUf~SV i LLE OR 97325 <br /> <br />USE or BUILDING <br /> <br /> CONTRACT CITY UGB <br />r4ARiON 6~¢N rY NO <br /> <br />9'148 8A'f~ RD SE <br />AUI'4SVILLE, OR 9'1325 <br />PHONE: 585-1782 <br /> <br />LOT BLOCK SECTION <br /> <br />CATEGORY <br /> RESI DEN i IAi. <br />OCCUPANCY <br /> <br />OCCUPANT LOAD <br /> <br /> Si1E NU~ER: 11405 <br /> VALUATION: <br /> <br />31 8S 1~ AR 48 <br />t.77 AC YP-.~ NO <br /> <br />NO OF BEDROOM& <br /> <br />fIYPE~ ELECIRiCAL <br /> <br />CONH~Ac'roR. NO. <br />LICENSE NO: <br />NiCHOL, GL,EN ~. <br />9748 BALES RD SE <br />AUNSVILLE, OR 9?325 <br />PHONE: 585-1782 <br /> <br />PBR~411 OR APPLICAFION NO; 28243 <br /> <br /> ~PERVISING ELECIRICiAN/NUI'~BER <br /> <br />f~ANUFACFURED HCC4E ~EI-A/ICE/F~DER <br />FLEEI ~URCRARGE -ZONE 3 <br />ELS, CFRICAL SfAfE SURCHARGE <br /> <br />TOTAL ~SBF:xSED FE~ <br />PREWiOUS RECEIPTS <br />'IHiS RECEIPT <br /> <br />BALANCE DUE <br /> <br />QUANTITY ~NI <br /> 2 $70.00 <br /> <br /> $3.50 <br /> <br />?7.34 <br />77.34 <br />$o+oo <br /> <br /> PAYEE: RECEI Pl NO; <br /> RECEIVEO BY.' pr' I'YPE: CHECK ;~.~ 0 <br />~ THIS iS A VALID PEI~IT * THiS PERffilT ~PiR~ 180 ~ F~ ITS I~E ~rE. IF <br />~ST~OTI~ C~ FOR A P~RiOD ~ 180 ~, OR I~ ~ST~OTI~ ~Ai~ TO ~EET ALL <br />R~IR~TS 0~ STATE ~ ~O ~RI~ ~NTY BUILDING ~O Z~iNG ~DIN~C~, THI~ ~IT <br />~ALL BEdE NULL ~D VOID. <br /> <br />REMARKS*. MH q'¢C/CC~ R~4245 <br /> <br />OFFICE COPY <br /> <br /> <br />