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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 22.5 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:80 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am pedorming work on a property I own or occupy. <br />I am a registered builder OR the authorized representative <br />of a registered builder, <br />The work will be performed by a registered builder. <br />Othar. <br /> <br /> I) ETRO I T <br />'USE o~ 6OYEdi~; <br /> <br /> TAX LOT ............... I CACEGORY. ' <br /> <br /> ,. P.], .-, -. 6ONTRAOT CITY UGB ~OOCUPANT LOAD' <br />EkE I TEIIB J,:,,l UPPEZR RESO SE <br /> OR MARIOI,I [.[)llq~Y' ' NO <br /> ...................................... ¢ ..... ', N0 0¢ <br /> <br />SUBDIVtSION <br /> <br />PO BOX 578 <br />:OE:TRD ]]T 97;~42 <br />PHONE:t E~,.~ 4 '-'....'~ :~. 4 <br /> <br />LOT; BLOCKz <br /> <br />WIDTH <br /> <br /> ............................ 86 ......... AC <br /> <br />;DEPTH: <br /> <br /> SIT NUMBER: <br />SECTION TOWNSHIP qAN ~E: ! :~O~qE'. I MAP'. <br /> <br /> ............ NO ................ L... NO ....................................... <br /> <br />TYPE: ELECTRICAL PERMIT OR APPLICATTON NO: <br /> <br />CONTRACTOR, hi(:),, 6r/,)224 <br />I... I C E N!!H;_'; <br />IlqNAL, O I:~ TABER <br />820 Iq I:U[VER ST <br />F'OF~TL AI,II),~ 972,'i~7-..F~ 0(,)0 <br />Pt,,IONE I: 282-5279 <br /> <br />SUPERVISING E L E:C.T R ]: C :t; A N/Iq UM;9 E R <br /> <br />SERVIC. E/FEE]OISR LESS THAI,i 2~t0 AMF'S <br />;FIRANCH CIRCUIT,~ W~:'T'H SERVil;CE (}R FEEl)ER <br />EI,,.ECTI;:;[CAL STATE SURCHAR6E <br /> <br />QUAN-F:[-i'Y AHOUN1- <br />1 $50. <br />6 $:1.2,, 00 <br /> $S,, 10 <br /> <br /> :¥'H~:S RE.C,,F,,.IPI ,'1~0,, 08 <br /> BALANCE DUE $0.0~ <br /> <br /> PAYEE: <br /> RI~:OE :I: P-f <br /> REC!~::[VI~:I) FY[t i)H2 ;,; ..... z .. 4 ,, <br /> <br />~8NSTRUCTIBN CEASES FOR ~' PERZO~ OF ~Se DAY8~ OR IF CONSTRUCTION FAILS TO MEET ALL <br />RE~UZRE~ENTS OF STATE LA~8 AN~ MAR~ON COUNTY BU~LgzN6 AN~ ZONZNE ORdINaNCES. TH~8 PERHZT <br />SH~LL ~ECOME NULL AN~ <br /> <br />FO~, ~c ~s,~ n~v. 4/~o OFFICE COPY <br /> <br /> <br />