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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 /> ~ am a registered builder OR the authorized representative SIGNATURE OF <br /> The work will be performed by a registered builder, <br /> <br /> DATE: 09/08/92 TIME: 8:14:26 <br />' OWN~n: !TX×' bOf: <br /> ROSE, <br /> FRANKLIN <br /> <br /> 11~44 JAMES WAY SE <br /> AUMSVILLE OR 97'~25 ! RW&r~Olq' ~T~UNTY ! ~19; , OCCUPANT LOAD: <br /> <br />: c~NT I AL <br /> <br />5210 RIVER ROAD N ~1000 ~ <br />PHONE: $90-9~5~ ' VALUATION: <br /> <br />8LOOK; SECTION'. TOWNSHIP: r RAN(~E: ZONE: MAP'. <br /> 29 8S ! 1W i AR . 48 <br /> <br />TYPE: ELECTRICAL PERMIT OR APPLICATION NO: 9042401 <br /> <br />CONTRACTOR, NO. <br />LICENSE NO: <br />ROSE, FRANKLIN <br />5210 RIVER ROAD N ~1000 <br />KEIZER 97~0~ OFFICE <br />PHONE: <br /> <br />SUPERVISING ELECTRICIAN/NUMBER <br /> <br /> ITEM QUANTITY <br />MANUFACTURED HOME SERVICE/FEEOER 1 <br />8RANCH CIRCUIT. WITH SERVICE OR FEEDER 2 <br />ELECTRICAL STATE SURCHARGE <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />AMOUNT <br /> $40.00 <br /> $4.00 <br /> $2.20 <br /> <br />$46.20 <br /> $0.00 <br />$46.20 <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE= ROSE~ FRANKLIN RECEIPT NO: 44466 <br />RECEIVED BY. DM2 TYPE: CK CHECK ~: 1006 <br /> <br />* THIS IS NOT A PERHIT. THIS APPLICATION HUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST SE COHPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFORMATION HAS BEEN PROVIDED. <br /> <br />PLAN REVIEW~ BY .......... DATE ..... CITY JURISDICTION: BY ........ DATE <br />REMARKS: MFQ HOME SERVICE/1CIR FOR WELL/1CIR FOR GARAGE <br /> <br />FORM # MC 15-56 REV, 4/90 <br /> <br />OFFICE COPY <br /> <br /> <br />