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MARION COUNTY BUILDING INSPECTION <br />SENATOR SLDG, 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 />I )~'"¢Vl am performing work or~ a greperty I own or o¢¢ugy, <br /> ~ sm a registered builder OR ) the authorized representative <br /> o a registered builder, <br /> The work will be performed by a registered builder, <br /> Other <br /> I have read and agree to the terms stated on the reverse side of <br /> this document, <br /> <br /> BATE: 09/14/92 TIME; 9;11:~9 <br /> KLEIN~ LARRY <br /> <br />......... ............... i <br /> , 56401000 RESIDENTIAL <br /> <br /> !OONSTRUCTION TYPE'· i o~cuPANGY: <br /> <br /> flUNSVILLE OR ¢7525 <br /> ¢ ~'R I"Ol, I 12'OUN T Y ~ NO <br /> <br /> 9804 MILL CREEK RD SE <br /> AUMSVILLE, OR S[TE NUHBER: 92-0325~ <br /> PHONE: 74~2405 ~ V~LURT[ON: <br /> <br />:LOT, ?LOOK: ~ SECTION: ~ TOWN~HIP'. .~ RANGE'. <br /> '1 ~ ~0 i 8S 1N R~ ' 48 <br /> <br />TYPE: ELECTRICAL <br /> <br />CONTRACTOR, No. <br />LICENSE NO: <br />KLEIN, LARRY <br />9804 MILL CREEK RO SE <br />AUHSVILLE, OR <br />PHONE: 749-2405 <br /> <br />PERHIT oR APPLICATION NO: 904251i <br /> <br /> SUPERVISING ELECTRICIAN/NUMBER <br /> <br /> ITEM <br />MANUFACTUREO HOME SERVICE/FEEOER <br />ELECTRICAL STATE SURCHARGE <br /> <br />QUANTITY AMOUNT <br /> ~ $40.00 <br /> $2.00 <br /> <br />TOTAL ASSESSED FEES $42.00 <br />PREVIOUS RECEIPTS $0.00 <br />THIS RECEIPT $42.00 <br />B~L~NCE DUE $0.00 <br /> <br /> PAYEE: KLEIN, LARRY : RECEIPT NO! 44578 <br /> RECEIVED BY: cl ...... TYPE: OK CHECK ~. 106~ <br /> <br /> * THIS IS NOT ~ PERNIT. THZ;S THROUGH A REVIEW PROCESS NHERE THE <br />FOLLO~IHG ~U~T BE CO~PLETEO. iT [~ THE REBPGHS[~iL[TY GE THE APPL[CRHT TO ASSURE THAT <br />ALL NECESSARY INFORHAT~ON HAS BEEN PROVIDED. <br /> <br /> PLAN REVIEW: BY ......... , 9~TE ........... CITY ~URISOICTION: BY ........ gATE ........... <br /> <br />REMARKS: MFG SVC FOR HDSP <br /> <br />OFFICE COPY <br /> <br /> <br />