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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH ST.~EET NE <br /> SALEM, O~REGON 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 adroperty I own or occupy <br />I am a registered builder OR the authorized represen a ye BIGNATURE OF APPLICANT: <br /> of a regis ered bu der, <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 DATE: <br />this document. <br /> <br />s,~us A~ AZR PA'TROL (AURORA. AZrmoR'r) co.s~uC~,o~ ~,~=' ?~:~;~iAL . <br /> <br /> ].4J~57 KEZL RD NE <br /> AURORA OR 9?8¢.2 ................ ~AR;[ON COlJNTY NO <br /> <br />: MAIL. lNG <br /> <br />SUBDIVISION <br /> <br />,LOT: <br /> <br />WfDTB: <br /> <br />PHOHE: <br /> BLOCK <br /> <br /> SITE NUMBER: <br /> VALUATZDN: <br />TOWNSHIP; RANGE: <br /> <br />OEPTH AREA ............ t,J [~L'T~; .............. RRES. LO"": <br /> <br />............................................... NO <br /> <br />TYPEs ELECTRICAL <br /> <br /> _IEENSE HO: <br /> <br />PO Box 845 <br />~ilsonvj. lie,, 97870-0000 <br />F HON'~;: 638-535~ <br /> <br /> I <br />BRANCH C:[RCUIT~ WI'FHOUT SERVICE OR FEEDER - 1ST CIRCUIT <br />[RANCH CIkCUI~ W.tTHOUT SERVICE OR FEEDER EACH ADDITIOHAL <br />ELECTRICAL STATE SURCHARGE <br /> <br /> TOTAl. ASSESSED FEE~ <br /> PREVIOUS RECEIPTS <br /> THIS RECEIPT <br /> 9ALANcE ~UFZ <br /> <br /> PERMIT OR APPLICATION NO: 5~;97~I <br /> <br />757,52 SUPERV,~SING ELECTRIC]:AN/NUHBER <br /> <br />QOAH'flTY <br /> 1 <br /> 2 <br /> <br />AMOUNT <br /> <br /> $4.00 <br /> iH.,,95 <br /> <br />$40.95 <br /> <br />$40.95 <br /> <br />$0.00 <br /> <br /> PAYEE: Wilsonville Electric ./mc RECE'rPT 1,10: 564J8 <br /> RECEIVEI) BY: I)M2 .................................................... i__. , TYPE: CK CHECK ~: 1891 <br /> * THIS IS A VALID PERNIT * THiS PERNIT EXPIRES 188 BAYS FROM ITS ISSUE DATE. <br />CONSTR~CTION ~EASES FOR A PERIOD ~OF 18~ BAY~ O~ iF ~ON~TRUCTION FAIL~ TO MEET ALL <br />REQUZREHENTS OF STATE LAWS AN~ MARION COUNTY BUILDIN6 AH9 ZONING ORBINAHCES, THIS PERMIT <br />SHALL BECOME NULL AN~ <br /> <br /> M_MARK,~,, 3 CIR IN OFFICE <br /> <br /> DONALD ¢~,. WOO~LEY,¢ HARIOI4 COUNTY BUILDING OFFICIAL / BY <br /> <br />Po~,~ =c ~=.se ~v, 4¢0 OFFICE COPY <br /> <br /> <br />