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MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br /> <br />I)ATE/TIHE <br />~TYPE <br />OCCUPANCY <br /> <br /> 285 ChurCh Street NE * Room 132 · Salem, Oregon 97301-3670 <br /> Office Hours: 8:00-4:30 · Phone: (50~) 588-5147 * 24-HR Inspection Line: (503) 373-4427 <br /> <br />86/17/96 ;, 16:13 ELECTRICAL APPLICATION <br />Resident. ) addition/alteration <br /> <br /> I)E,SC : MO SERVIC~ FOR HARDSHIP <br />S%TE ADDRESS : 10~25 MIX.RD SE AM <br />CROSS STREET : POR[ER RI) SE <br /> <br />PARCEk NUMBER ~ ~40491-080 <br />OWNER NAME : H~%~P~SLEY & ~LSIF L <br /> <br />APPLICANI <br /> NAME M[X.JERf) LD <br /> ADDRESS ~ RD <br /> '- ' 4778 ,.IONE~ SE <br /> SAL~;M <br /> <br /> PHONE : 581-~9'22 <br /> <br /> ) 1 , MIX, JEROLD <br /> .( NTRACT{ <br /> PHONE : <br /> <br /> PHONE <br /> <br />SIIPV EI.EC <br />PHONE <br /> <br /> tI. <br /> <br />973~7 <br /> <br />Description <br /> ..t~,an-~, dw~ [llng service/~e'~ <br /> State surch~r'ge <br /> Refund <br /> <br />ACTIVITY NO : 96-84390 <br />STATUS : APPLIEI) <br />APPLIED : 06/17/1996 <br />TO EXPIRE : 12/14/1996 <br /> <br /> OCCB: <br />CONTRACTOR LICENSE: <br />SUPERVISOR LICENSE: <br /> <br />CITY: MARION COUNTY <br /> <br />Fee <br /> <br /> A~sPssed fees : 42.00 <br /> Adjustments : .00 <br /> Total fe~s : 42.00 <br />P~YF~:: MIX~,JERF)Lt) Total p~yments: 4,~. ~8 <br /> Balanc~ due : .08 <br /> <br />THI~ JS HOT A PERHIT. iT l~ THE RESPOHSI~ILJTY ~ THE ~PPL]CAHT TO ASSURE THaT <br />AI.L NECESSARY IHFORflATI~ IS ~OVIDEO AND FEES PAID BEFORE A P~fllT HAY BE ISSUED. <br />SI~NA'FURE-, OE AFPLICANT:" __~~~ .................... <br />~flN~J ~ E. ~IIOPLEY. H~]ON COUNIY BU]LDTN~ OFF'[CZAL BY H~UL.L <br /> <br />............................................... FO~ OFF]CE USE 0NLY ....................................... <br /> <br /> MAI,': 7ONE: PROPERTY LOCAT['IR~ <br /> F'LAN REVXEW= ;)ATE: ZONING REVIEW: gATE: <br /> <br /> <br />