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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 588-51'47
<br /> CODE-A-PHONE 4:30 P.M, - 8:00 A.M,
<br />
<br />I am performing work on a property I own or occupy.
<br />I am ~ registered builder OR the auti~orized representative
<br /> of a registered builder,
<br />1'he work will be pedormed by a registered builder.
<br />Other
<br />I have read and agree to the terms stated on the reverse side of
<br />
<br />CCA, KLEY, RODNEY &
<br />
<br /> 5?85 SH Ale'
<br /> , ,~,lv.2 ,/..
<br />USE OF BuiLDiNG:
<br />
<br /> ~ TAx LOT; CATEGORY:
<br />
<br /> ¢ CONTRACT Cl+~F: UGh: OCCUPANT LOADJ
<br /> OR 97~25
<br />.................... MARiaChi ~NTM NG ·
<br />
<br />MAILING ADDRESS: .............
<br />
<br />CULVER LANE SO
<br /> 9700,,
<br /> 352-6508
<br />
<br /> SITE NUIviaER: 3 ', 93
<br />.......
<br />
<br /> : UNITS'. i IRRE~. LO'r: CORNER'.
<br />
<br />TYPE: ca,,,, EC T,~ ~. C,AL
<br />
<br />CONT'RAC-f'OR, NO,
<br />L:;EE?~SE
<br />COAKLEY, RODNEY & MARIA
<br /> ;85 CU,_VER LANE SO
<br />SALEM 9?3O2
<br />
<br />,~ERM~T OR ,APPLICATION NO: 6728
<br />
<br /> ;::,L P~.RV.~,.::[NG ,.,I_EC R,~ C iAN/N,. ~18 ,,
<br />
<br /> .~ TE,M
<br />C/I SERV 10'!~,200 AMPE,
<br />FLEET SURC!.4AR(]E .-ZONE 3
<br />ELECTRICAL STATE SURCHARGE
<br />
<br />wL, AN
<br />
<br />TOTAL ASSESSED FE, ES
<br />PREVZOU$ RECE]:FFS
<br />THI,,S REC~'i PT'
<br />
<br /> RECEIPT
<br />
<br />AMOUN'7
<br />
<br /> $ 3 . 84
<br /> ,!2 53
<br />
<br />RECE;V'ED SY: pb : ,TYPE,~ CHECX ~;:
<br />
<br />C~ST~CTI~ C~ FOR A,PER~OD OF 180 DA~, O~,' ZF{"~ST~CTZ~ FAZ~ TO ~E~T ALL
<br />REdIReCTS OF STATE ~
<br />~ALL BEdE NULL ~B ~IB.
<br />
<br />REMARKS; 2O0AMP FOR POLE BLDG
<br />
<br />~o~ ,, ~c ~5-s~ ~v em7 OFFICE COPY
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