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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 />( ) lam performing work on a property f own or occupy. T <br />( ~ I am a reg S ered builder OR ( ) he authorized representative SIGNATURE OF APPLICAN <br /> ~f a registered b¢lder, <br /> <br />( ) Other <br /> <br />, t;ff4F,,, 13.37. ~., ...... CAT~GORV: <br /> OWNE/~hTfT;i ].2/2';~/74,: r~ ;; ~ ~ TAX LOT: <br /> <br /> 96~7 BATES ROAD SE <br /> ALHSVI~LE OR 9732~ MARI[N gOINTY <br /> <br /> MAll. lNG ~O~1~'~'. ..................................... ! ~5~5'igi~i~'i ............. <br /> <br /> P HQHE,'; 74 ~,,,~2728 VALUA'r~ON: <br />LOT: ~ BLOCK: SECTION: ~ TOWN~HIP'. ~ RANGE; i ZONE: MAP: <br />,'W~D~H: .............................................. /DEPTH ~EA ~U~¢ ................ ~ ~ ~EG, LOT ' ~ER. ~8 <br /> <br /> w ,.- [ . .- .- ; } <br /> 1~ ................... 45~ ...... ~2-~ SF ............ ~ N~ <br /> <br /> TYPE: ELECTRICAL PERMIT OR APPLICATION NO: 68413 <br /> <br /> (,,OI'4IR~I.,YOR~ Ii0., ?3449 SUIbERVISIN6 ELE(.TR].I,.tAN/NUHr.~LF; <br /> LICENSE NO~ <br /> BILL, TRtJXAL <br /> 4552 CENTURY ~ S <br /> <br /> ~,¢ONE, 364-0472 <br /> :['rE;FI QUANTITY AMOUNT <br /> <br /> l- EE, DER 4 $8., <br /> BRAHCH (:~;IiRC;L~:(T. W~'CH ,SE:RV~CE OR ........ ' <br /> <br /> TOTAL, ASSESSE~ FEES $I;I,~. 4¢] <br /> P~EV):O JS: RECEI ~ T~ $e,, ~)~ <br /> 'H4ZS:RECEIPT: ~ 1 :i. 3,, 49 <br /> <br /> F'AYEE~ BILL, TR[JXAI.. RECE;[F~T N0'.: 63826 <br /> IYPE. CK CHECK 4h 774 <br /> · * THIS Z~ A VALID PERMIT ~ ;THI~' ~ERHIT EXP~RED 188 DAYS FROH ITS ISSUE ~ATE. IF <br />CONSTRUCTION CEASED FOR A PERIO~ OF 188 DAY~, QR ~F CONSTR~CTIQN FALLS TO HEET ALL <br /> <br />SHALL B~CO~E NULL AN~ VOI~. <br /> <br />~K'/Nr'fl h K., t~IF(,I]OL~:'Y,,. MPrR:!'ON lit'JUN-fY BU]:L.D:[N(;. OF:,';'Z[;IAL. / <br /> <br /> OFFICE COPY <br />FORM # MC 15-56 REV, 4/~t) <br /> <br /> <br />