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MARION COUNTY BUILDING INSPECTION <br />SENATOR 8LDG, NO. 225 <br />22~ HIG~$TREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />l am a registered builder OR ( ) the authorized representative <br /> <br />The work will be ~erformed by a reglstered builder, <br />O~her <br /> <br /> I have read and agree to the terms stated on the reverse side of <br /> th~s document, <br /> <br /> DATE: 08/17/92 TIHE: 8:44:27 <br />OWNER' <br /> FOX <br /> <br />SITUS ADDRESS' <br /> <br />SIGNATURE OF APPUCANT: <br /> DATE: <br /> <br /> TAX LOT <br /> <br /> CONSTROCTION TYPE~ <br /> <br /> 14444 EHLEN RD <br /> AURORA <br /> <br />USE OF BUILDINg; <br /> <br />~AILING ADDRESS: <br /> <br /> NE <br />OR 97002 <br /> <br />CONTRACT CITY UGB <br />HARZON COUNTY NO <br /> <br />SUBDIVISION <br /> <br />CATEGORY. <br /> RESTDENTIAL <br /> <br />OCCUPANCY: <br /> <br />OCCUPANT LOAD <br /> <br /> PHONE: <br /> <br />LOT'. BLOCK; SECTION <br /> <br />WIDTH: DEPTH; AREA: <br /> <br />SITE NUHBER: 92-029~7 <br />VALUATION~ <br /> <br />TOWN~HIP ..... ~AN~E ..... ZONb <br /> <br />UNIT~c iRREG _OT OORNE~ <br /> NO NO <br /> <br />MAP' <br /> <br />TYPE: ELECTRICAL PERHIT OR APPLICATION NO: 9041898 <br /> <br />CONTRACTOR, NO. <br />LICENSE NO: <br /> J & V ELECTRIC <br />PO BOX 80 <br />HOLALLA, 97038 <br />PHONE: 829-7762 <br /> <br />57387 <br /> <br />SUPERVISING ELECTRICIAN/NUHBER <br /> <br /> ITEM <br />SERVICE/FEEDER LESS THAN 200 AMPS <br />ELECTRICAL STATE SURCHARGE <br /> <br />QUANTITY AHOUNT <br /> 1 $50.00 <br /> $2.50 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$,52-50 <br /> $0_00 <br /> $0.00 <br /> <br />* THIS IS NOT A PERHIT. THIS APPLICATION HUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING HUST BE COHPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFORMATION HAS BEEN PROV[OEO. <br /> <br />PLAN REVIEW: BY ........... DATE ............. <br />REMARKS; SERVICE CHANGE <br /> <br />CITY JURISDICTION: BY .............. DATE ....................... <br /> <br />~o.~ ~ ~o ~-~ ~Ev, ~mo OFFICE COPY <br /> <br /> <br />