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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br />The work will be performed by a registered builder. <br />Otb ............. <br /> <br />this document. <br /> PARKER~ SHERRI <br /> <br />'OWNER; <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> RESIOENTIAL <br /> <br />TAX LOT: CATE(~O RY'. <br /> <br />ADDRESS' 577.5 SHAW HWY <br /> 'AUHSVILLE <br /> <br />oR 97523 sE :'Cot~c~:~(~.T'b~,~'~,Ty. NO I bCsuk~NC¥; <br /> <br /> CONTRACT CITY: ~ UGB; OCCUPANT LOAD: <br /> <br />'U~b O# BU~L. DiNC: ......... ' .... <br /> <br />LOT: <br /> <br /> 18 88 iW AR 46 <br /> <br />TYPE: ELECTRICAL PERN~T OR ~PPLZC~T~ON NO:: 9042057 <br /> <br />CONTR~C-FOR, NO. <br />LICENSE NO: <br />PARKER, SNERRi <br />SAME <br /> <br />SUPERVISING ELECTRICIAN/NUMBER <br /> <br />PHONE: ~64-.0626 <br /> <br /> ITEM QUANTITY <br />BRANCH CIRCUIT, WITHOUT SERVICE OR FEEDER ,~ iST CIRCUIT 1 <br />BRANCH CIRCUIT~ WITHOUT SERVICE OR FEEDER - EACH ADDITIONAL t <br />ELECTRICAL STATE SURCHARGE <br /> <br /> TOTAL ASSESSEO FEES <br /> PREVIOUS RECEIPTS <br /> THIS RECEIPT <br /> <br /> BALANCE DUE <br /> <br />PAYEE; PARKER, SHENSI. I~ RECEIPT NO: <br />RECEIVED BY: NB ....................... - <br /> %,.,~,7,~ TYPE; CK CHECK ~: <br /> <br />AMOUNT <br /> $55_00 <br /> $2.00 <br /> Si_as <br /> <br />$38.85 <br /> $0.00 <br />$58.85 <br /> <br />$0.00 <br /> <br />44101 <br /> 932 <br /> <br />~ THIS IS NOT A PERMIT. THIS APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST BE COMPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFORMATION HAS DEER PROVIDED. <br /> <br />PLAN REVIEW: BY ............ DATE <br />REMARKS; 2/CIR <br /> <br />CITY JURISDICTION: BY ............. DATE <br /> <br />FORM # MO 15-56 REV. 4790 OFFICE COPY <br /> <br /> <br />