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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 />SIGNATURE OF APPLICANT: <br /> DATE; <br /> <br /> DA'[E; 12/3fJ/9'1 TIME: 9 28z56 <br />OWNER: TAX <br /> <br /> 11654 LARK COURT NE ' CONTRACT CITY: <br /> AURORA OR 9?002 : <br /> <br />USE OF BUILDING: <br /> <br />NO <br /> <br />: CATEGORY: <br /> <br /> OCCUPANCY: <br /> <br /> OCCUPANT LOAD: <br /> <br />MAILrNG ADDREGS: <br /> <br />SUBDIVISION: <br /> <br />CENfURY Iv]E~DrJW~ :~4 <br /> <br /> PHONE: <br /> <br />LOT: <br /> <br /> '10 <br /> <br />Ri OC~: ; sEdYJo~: YOw~SHi~: <br /> <br />5lf'E NUMBER: <br />VALUAIION: <br />,RANGE: ZONE~ <br /> <br />15058 <br /> <br /> 33 30 ,, ].~ ...... AR <br />55 85, 5100. SP' NO i NO <br /> <br />MAP: <br /> <br />ELECTRICAL PERMIr OR APPLiCA'FI()N NO: 3V67~ <br /> <br />CON'fRAC'IOR, NO. 04259 <br />LICENSE NO: <br /> Rfiche~ E'lectnffC Co <br />395 Flanker St NE <br />~'lem, 97301-0000 <br />PHONE~ 352-4156 <br /> <br />SUPERVISING ELECTRiCiAN/NUMBER <br /> <br /> i'IEM <br />~.z!J'~UP'AC'}URE~ H©~E ~ERViC~/FEED~R <br />EI,..ECf'RICAL ~TA'I'E SURCHARGE <br /> <br />'f'O'fAL ASSESSED FEES <br />PREVIOUS RECE~P'f'S <br />THIS RECEIPT <br /> <br />0UAN 1' .[ 'IY AM(0LIN I <br /> 1 $35,00 <br /> $ 'r _ '75 <br /> <br />$36.75 <br /> $0,~0 <br />$35,75 <br /> <br />i~ALANCE DUE $0.00 <br /> <br />RECEIPT NO: 39550 <br /> <br /> RECEIVED BY; PB TYPE: OK CHECK ~: 3962 <br /> <br />* THIS IS A VALiD PER~IT ~ THIS PER~flZT EX~iRI"~ 180 DAYS FROM 1T~ iSSUE DATE. IF <br />CONSTRUCT/ON CEAS[~S FOR A PERIOD OF 180 DA~, OR IF ~T~CTI~ FAI~ TO ~EET ALL <br />RE~IR~TS OF STATE ~ ~O ~Ri~ ~NTY BUILDING ~O Z~IN~ ORDiN~C~, THIS PEril <br />~ALL BEdE NULL ~D VOID. <br /> <br />I.)ONALD E. NOODLEY, MARION COUNt'Y BUILDING OFFICIAL / BY ................................ f~ ........................... <br /> <br /> · ' OFFICE COPY <br />FORM # MC 15.56 REV. <br /> <br /> <br />