Laserfiche WebLink
MARION COUNTY BUILDING INSPECTION <br />SENATOR"BLOC, ,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 />I am perforT'aind work on a property I own or OCCUpy. <br />I am a registered builder OR ( ) the authorized representative SIGNATURE OF APPLICANT: <br />of a registered builder, <br />The work will be performed by a registered builder. <br /> <br />I have read and agree to the terms stated on the reverse side of BATE: <br />this document, <br /> <br />owP~!'E: 12/06/90 '~'~E; 10;47=46 <br /> <br /> KNOX, MICHAEL G & L~NOA L <br />SITUS ADDRESS: <br /> <br /> 8691 PETERS ROAD <br /> AUIvISVILLE <br />pSE OF BUILDING: <br /> <br />TAX LOT~ <br /> <br /> : CONSTRUCTION TYPE; <br /> <br /> SE cG NTRAOT Ci~: UGBI <br />OR 9?325 : <br /> MARION COUNTY NO <br /> <br />SUBDIVISION: <br /> <br />RES I DgNI' i AL <br /> <br />OCCUPANT LOAD: <br /> <br />10965 JAM~ HAY ORIVE <br />AUFCSVILLE 97325 <br />PHONE; 749-2155 <br /> <br />LOT: BLOCK: <br /> <br />SE <br /> <br /> 511'E NU~IBER: 9586 <br /> VALUA'~ ! ON: <br /> SECTION: ~0WNBHIP: RANGE: ZONE: <br /> <br /> '~9 8,~ CORNER: <br /> AREA: , UNITS: IRREG. LOT: '~1 AR <br /> ~ AC Y~ NO <br /> <br />MAP: <br /> <br /> 48 <br /> <br />TYPE: ELECTRICAL <br /> <br />CON?RACTOR, NO. <br />LICENSE NO: <br />KNOX, NICHAEL G & LiNDA L <br />10965 JA~ES ~AY DRIVE SE <br />~J~VILLE 9?325 <br />PHONE: 749-2155 <br /> <br />PERt411' OR APPLiCATiON NO: 9029126 <br /> <br /> SUPERVISING ELECTRIC[AN/NUMBER <br /> <br />r~ANUFACTUREO HC)f~IE SERViCE/FEEDER <br />ELECTRICAL STA'fE SURCHARGE <br /> <br />PAYEE: KNOX, MICHAEL G & LINOA L <br />RECEIVED BY: <br /> <br />(,~JANI'I'I'Y <br /> 2 <br /> <br /> TO'rAL:A,,,S~EB FEE~ <br /> PREViC~J$ RECEiP'rS <br /> 'tHIS RECEtP'r <br /> <br /> BALANCE OtJE <br /> <br /> RECEIPT NO: <br />D~12 ................................................. :.: ............................................ TYPE; CK CHECK <br /> <br />A~OUN'I' <br /> $70.00 <br /> $3.50 <br /> <br />$73.50 <br /> $o.00 <br /> <br />$o.oo <br /> <br />30784 <br /> 2901 <br /> <br />* THiS iS NOT A PERNiI'. THI~ APPLICATION NUST 60 THROUEH A RE~iEN PROCETS~ [,~HERE THE <br />POLLOIN/NG f~UST BE CO¢4PLETEO. iTiSTHE RE,~.PONSISiLiTY OF THE APPLICANT TO AEC,SURE THAT <br />ALL NEC~ARY [NFOF~IATiON HA..%SEE~ PROVIDED. <br /> <br />PLAN REViEN: BY ................................... DATE ...................................... <br />REtCC. RKS: CONN/SERV <br /> <br />CITY JURtSDJC'f'iON: BY OA'fE <br /> <br /> OFFICE COPY <br />FORM # MC 15-66 REV, 4/90 <br /> <br /> <br />