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MARION COUNTY BUILDING INSPECTION <br />SCNATOR BLDG NO 225 <br />220 HIGH STREET NE <br /> SALEM: OREGON 97301 ~ <br /> <br /> PHONe:: 588-5'147 ~:00 - 4::30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />Other <br /> <br />D/AlE: 0S/'15/91 flN~"'_ 12:11:08 <br /> <br />SIGNATURE OF APPLICANT <br /> DATE <br /> <br />TAX LOT <br /> <br />CATEGORY <br /> <br />H,aLLb RI[)GE 5UIVlMi [ <br /> <br />NO <br /> <br />OCCUPANCY <br /> <br />DEiP,_RNGR /tCCO BOX 320 MiLL CiTY <br /> h,lh,,fldOR~ 1628 NW EVERETf PORfLND <br /> 228-2252 <br /> <br />SiIE NUMBER: <br /> VALUAI'ION: <br /> <br />LOT BLOCK SRCTION TOWNSHIP RANGE ZONE <br /> <br />WIOTH DEPTH AREA UN~TS IRREG LOt CORNEB,., <br /> NO <br /> P4U <br /> <br />[YPI;: EL_ECfRICAL PERMii OR APPLICATION NO: 34482 <br /> <br />,SUPERVi5 ING bLECT RiOIAN/NUMBER <br /> <br /> [ff EM <br />ULRYLr,,,'~/PbbO~-~R 101 f(,) 400 A~P5 <br />L L~zC ! R ¥ CAL ~ T/~ I L L~URCBAF,~"GE <br /> <br />{)UAN <br /> <br />4 :~'24 0 <br /> <br /> fOrAL ASSE$SEO FEES <br /> PREVIOUS RECEiPt5 $0. <br /> fHi5 REC~IP f' <br /> <br /> B~,,LANCE DUE f,:.} . <br /> <br /> PAYLL: NAIIONAL FORESf L~OS RECEi¢~ NO <br /> NI.::Cb:iVbU tdY: Olvl~ ~YPE: CK CHECK ~: <br /> <br />~ THIS i~ A VALID P~iT ~ THiS PE~IT ~Pi~ 180 ~Y~ ~ iTS I~E ~TE. <br />r~s-r~cT~ C~ FOR ~ PERIOD OF 180 ~, OR I¢ ~T~CTi~ FAZ~ TO ~EET ALL <br />RE~IR~TS O~ STATE ~ ~0 ~RI~ ~NTY BUILOiNG ~O Z~iNG ORDIN~C~, THiS PE~iT <br />~ALL 8~E NULL ~D VOID. <br /> <br />L)i )FI~,I.. D E, <br /> <br />I~OOBLEY, ~ARION COUNTY BUILDING OcFiC~4L / BY <br /> <br />FORM ~ MC 16-66 REV 4~90 OF FiCE COPY <br /> <br /> <br />