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MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> <br /> 285 Church StmetNE · Room 132 ·Salem, Omgon97301-3670 <br /> Office Hour:8:00-4:30 * Phone:(503)588-5147°24-HRInspectlon Line:(503)373~427 <br /> <br /> ELECTRICAL PERKIT <br />DATE/TIKE : a2/ec/97 e?:54 PERKIT M0 96-g8337 <br />TYPE : New Residential STATUS ISSUEO <br />OCCUPANCY : R-3 ISSIJED 02/~6/1797 <br /> TO EXPIRE D8/~5/1977 <br /> <br />WORK DESC : MD SERVICE RELOCATE <br /> <br />SITE ADDRESS : CITY: MARION COUNTY <br /> 12855 NEAL ST SE AM <br /> <br />C, ROS,~ , TREET : STAYTON RD <br /> <br />PARCEL NUHB~,R : 7.~580-898 <br /> <br />OWNER HAME : HOLLIH(,SWORTH~ALTA & RO;~ERT <br /> <br /> , <br />APFLI,ANT <br /> NAME <br /> ADDRESS <br /> <br />PHONE <br /> <br /> · C ' <br />CONTRA ,T )R <br /> PHOHE <br /> <br />NOLLIHGSWORTH~ALTA & ROB.R~ <br />4684 BUENA VISTA RD S <br />J~FFERSOI4 <br />!'iR 77~52 <br />~27-192~ <br /> <br />ELE[,t ~J ,IAN : <br /> PHONE : <br /> <br />CONI'RAC [OR LICENSE: <br /> <br />SUPV FLEC ." <br /> PHONE <br /> <br />SUPERVISOR LICENSE: <br /> <br />[ ~its t)escr iotit ~'~ Fee <br />.... ~. ...... -PF~' d w ~ t T i'i'~-'-§~l i""~-£ ~-e / f e~ ~ ........................................... ~ <br />1 State Surcharge 2.~8 <br />I Re fut~ , ~ <br /> <br /> Assessed fees : 42,00 <br /> Ad jushqents : .eO <br /> Total fees : 42.08 <br />PAYEE: HOt.~ IHGSWOR"'H,ALTA & ROBER~ Total paxMents: 42.00 <br /> Balan~:~ due : <br />*************************************************************************************** <br /> <br />THIS PERMIT IS ~OH-TRAHSFERABLE AND EXPIRES 188 DAYS FROH ISSUE DATE IF ~ORK HAS <br />HOT COHHEHCED, OR IF CDHSTRUCTIOH CEASE5 FOR A PERIOD OF 188 DAYS, OR IF WORK <br />FAILS TO HEET ALL REQUIREHEHTS ~ STATE LAWS AHD HARIDN COUHTY ORDINANCES. UPON <br />WRITTEH REQUEST, OHE SIX HONTH EXTEHSIOH HAY ~ ~AHTED. <br />StGNATdRE OF AFPLICANT: ............................. ~ <br /> <br />DONDAI,D E WOODLEY, MARION COUNTY BUILDINBG OFFICIAL / BY CLYNCH <br /> <br /> <br />