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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: 588-5147 8::00 - 4::30 <br />24 HOUR CODE-A-PHONE:: 588-7904 <br /> <br />51GNATURE OF APPLICANT :~ /~/?/,~_.~..~_,,A~ <br /> <br />LANKFORU, MC~ R. <br /> <br />TAX LOT CATEGORY <br />CONSTRUCTION TYPE OCCUPANCY <br /> <br />RES [ I.)EN T ~ At,, <br /> <br /> 1 I688 WA~LER LANE NE <br />AURORA OR 9?002 <br /> <br />USE OF BUILDING <br /> <br />CONTRACT CITY UGS <br />fqARION COUNfY , <br /> <br />NO <br /> <br />OCCUPANT <br /> <br />AL SCHI~I,f, OHANER ,~ AGEN [ <br />RE) ~OX 6859? OAK GROVE, <br />~ONE: <br /> <br />LOT BLOCK <br /> <br />/0 ~0'? <br /> <br />654-4%/.9 <br />ORE 9!268 <br /> <br />SUBDIVISION <br /> <br />CEN:URY MEABO~ PHAS~ 4 <br /> <br /> ~11E NUMBER: <br /> VALUAIiON: <br />SECTION ~OWNSHIP RANGE <br /> <br /> SP YE5 <br /> <br />NO <br /> <br />IYPg: bL~CTRZCAL PERfflif OR APPLICAfION NO: 9034~43 <br /> <br />CONTRACTOR, NO. <br />LICENSE NO: <br />L,.ANKFORB, MOB <br />AL SCHN~OHAMgR <br />PO BOX 6859t OAK GROVE, ORE 972 <br />PHONE: <br /> <br />S~JPERVISING ELECTRiCIAN/NUMUgR <br /> <br /> iIE~ <br />~ANUPAC[UR~ HCe','IE SERViCE/~E~ER <br />EL_EOIRiCAL $1AfE 5UI~CHARG~ <br /> <br />QUAN¥i~Y AMOUN/ <br /> 2 $?0,00 <br /> <br />'f'OfAL A,.,%.SES~EB FEES <br />PREVIOUS RECEIPI5 <br />THiS RECBiP'f' <br /> <br />SYJ, ~9 <br /> $0.oo <br /> $o o0 <br /> <br /> ~ALANCE DUE <br /> (--% $'~, ~9 <br /> <br /> PAYEE: . ~ R~CEiPf' NO: <br /> RECEIVED BY: DM2 _~_ TYPE: CHECK ~: 0 <br /> <br />~ THiS iS NOT ~ PE~IT. TNIS ~PPLiCATION I¢IJST GO ~HROUGH A REViE~ PROCESS ~ERE fRE <br />¢OLLO~iNG f~UST BE COf4PLETED~ iT iS THE RESPON$IBILIT~ OP THE APPLICANT TO A~C~URE THAT <br />ALL NECESSARY INFOFC~ATION HAS BEEN PROVIDED. <br /> <br />PLAN REVIEW; 8Y <br /> <br />REMARKS: SERVICE & CONN <br /> <br />DATE Ci1Y JURISDiCltON: BY DA~E <br /> <br />pon~ # MC ~-~E R~v .~/~o OFFICE COPY <br /> <br /> <br />