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MARION COUNTY BUILDING INSPECTION <br />SENATOR BI~r).G, 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 />[ am performing work on a property [ own or occupy <br />I 8m a registered buirder OR the authorized representative <br />of a registered dulldor, <br />The work will be performed by a registered builder. <br />Other <br />I have read and agree to the terms stated on the reverse side of <br /> <br />SITUS AODRESS: <br /> <br />fX~ LOf: .................. <br /> <br /> 20448-000 <br /> <br />RESIOEN'flA~ <br /> <br /> 14694 KO'EL ~R'F NE <br />AURORA OR 97002 <br /> <br />~4755 ~ 85TH <br />'f'UALATiN, OR <br />PHONE: 838-8~91 <br /> <br />2.38 AC <br /> <br />AURORA .... NO ................... <br /> <br />SUBDIVISION: <br /> <br />tf-,ASEL..COUR1 _ , ~ <br /> <br />SiTE NUt4BER: 54.90 <br />VALUA'r i ON: <br /> <br /> NO ~ NO <br /> <br />TYPE: ELECTRICAL PE,~MI'F OR APPLICATION NO: <br /> <br />OON'I'~J~CIrOR, NO. <br />L~CENSE NO: <br />NAB & ,SONS ELEC <br />PO BOX ?? <br />MOLALLA 9?038 <br />PHONE; 829-8149 <br /> <br />6'1817 <br /> <br />SUPERVISING ELEC'T'R[CIAN/NUMBER <br />ROY 'FANKC~3LCY <br /> <br />RE~ NIRiNG < 2000 ~ FF <br />FLEET SURCHARGE -ZONE 6 <br />ELECTRICAL STA'f'E SURCHARGE <br /> <br />QUANTITY AI~OUNT <br /> I $?5.O0 <br /> <br /> 3.~5 <br /> <br />'TOTAL AgSSES, SEB FEES <br />PR~¥iOU$ RECEIP'FS <br />'l'HI~ RECEIPT <br /> <br />$86.43 <br /> $0.o <br /> <br />BALANCE ~JE <br /> <br /> PAYEE: NAB & SONS ELEC RECEIPT NO: 27099 <br /> RECEIVED BY: PR TYPE: OK CHECK ~: 725 <br />~ THIS IS A VALID PE~MIT * THIS PERMIT EXPiRE~ 180 DAY~ FROM iTS i.%.,~JE [)ATE. IF <br />~3T~CTI~ C~ ~R A PERI~ OF 180 DAYS, OR iF ~$T~CTi~ FAI~ TO ~T ALL <br /> <br />~ALL ~ NULL <br /> <br />RE~ARF, S: RES WiRiNG <~000 F'f' R:i~t2619 <br /> <br />~ONALB E. @DLEY, MARION COUN'T'Y BUILDING OFFICIAL / BY <br /> <br /> OFFICE COPY <br />FORM # MC 15-58 REV. 4/00 <br /> <br /> <br />