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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 225 <br />220 HIGH STREET NE <br /> SALEM, ORPGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR COD~=-A-PHONE: 588-7904 <br /> <br />have read and agree to the terms stated on the reverse side of <br /> <br /> EVERGREEN <br />SrTUS ADORESS' <br /> <br />TAX LOT: <br /> <br />CONSTROCTIO N ~YPE: <br /> <br />: CATEGORY: <br /> OCCUPANCY: <br /> <br />R ES L (,)EN f' ,( AL <br /> <br /> ~35 YEW <br />.AUF~rSV~ LL~ OR 97325 <br /> <br />CONTRAC ~ CITY: <br /> <br />,~JJC4SV 1 LLE <br /> <br />,NO <br /> <br />OCCUPANT LOAD: <br /> <br />MAILINO ADDRESS: <br /> <br />~UBDIVtS16Ni <br /> <br /> PHONE: <br /> <br />LOT; <br /> <br />BLOCK: SECTION: TowNsHiP: <br /> <br /> SITE NUMBER: <br /> VALUA'r ION: <br />RANGE; <br /> <br />ZONG: MAp: <br /> <br />]W~DTHi DEPTH: AREA: <br /> <br />UNITS. IRRE~i LOT: 6ORNERi <br /> NO ' NO <br /> <br />TYPE: ELECTRICAL PERMi'[' OR APPLICATION NO: <br /> <br />36412 <br /> <br />OONTRAC'I'OR, NO. 27459 <br />LICENSE NO: <br /> R & R E-iectrffc [nc <br />Po Box 52 <br />'fltjr~ep, 97392-0000 <br />PHONE: ?43-2546 <br /> <br />SUPERVISING ELECITIRICtAN/NUMBER <br /> <br />ABDIIIIIONAL FEES <br />ELECTRICAL STATE SURCHARGE <br /> <br />OUAN'tI l ~IY AIvIOuN T <br /> ~ $30.00 <br /> $1.5O <br /> <br />'TOIlAL A~ESSED PIE~ <br />PREVIOUS REOEipIFS <br />'~IHIS RECEIP'f <br /> <br />$:3 t, 50 <br /> $0,00 <br />$3~ _50 <br /> <br />,JALANCE OUE $0 , 00 <br /> <br /> PAYEE: R ~ R Elllectrfic inc RECEIP'f NO: 38343 <br /> RECEIVED BY: CL TYPE; CK CH~CK =: 9990 <br /> <br />* THIS IS A VALID PER,lIT * THI~ PE~llT IEXPIRE~5 180 DAYS FROI~ 1TS ISSUE DATE. IF <br />~STR~CTION C~F'q ~OR A PERIOD OF 180 DAY~, OR I~ (]~$TRUCTI~ FAiL~ TO ~EEI' ALL <br />~BQUIRF~F.N~S OP STATE LA~ AND ~ARION COUNTY BUIkDIN$ AND Z~NiNG ORDIN$~NC~. THIS P~R~IiT <br />2~l~ALL B~iC~ NULL ANDV~.~ID. <br /> <br />REMARKS: MFG SVC R~3030 <br />0ONALO E, WOOOLEY, MARION OOgNIIIy BUILDING OFFICIAL / BY ............................ ~ ................................................... <br /> <br />FORM # MC 15-56 REV, 4/90 <br /> <br />OFFICECOPY <br /> <br /> <br />