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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: G88-~147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />lam 8registeredbuJlderOR( )thecuthorized representative SIGNATURE OF APPLICANT: <br /> <br />The work will be performed by a registered builder, <br />Other <br /> <br /> JLIBB~ MARCY <br /> <br /> 20862 ?:[LBERT ST -- CONTRA'CT C~T¥: <br />AURORA OR 97002 AURORA <br /> <br /> NEW COLON' <br /> ~ITE <br /> <br />PHONE= <br /> <br /> : OCCUPANCY: <br /> <br />U~8: : OCCUPANT LOAD: <br />NO <br /> <br />LOT: <br /> <br />WlOTI'h !OEP+H: : ~REA; u~l'¢si <br /> <br />NO NO <br /> <br />TYPE: ELECTRICAL PERMIT OR APPLICATIQM <br /> <br />CO~'f'RACTOR, NO, 26071 <br />LILENSE' <br /> ,Canl:y I-':t.e?tn"ic Inc <br />??0 S Ivy St <br />Canby,¢ ,9'701%-0000 <br />PHONE: 266-7878 <br /> <br /> ITE~ <br />ELEblkZCAL STATE SURCHARGE <br /> <br />F'A?.i:E: [;anby t.-].l, ectric <br />RECEIVED BY: <br /> <br />THIS I~ NOT A PERMIT. <br /> <br />REMARKS: REFUND <br /> <br />9~§~072 <br /> <br />S~UPERVIS?NG EI_ECTR Z CI:AN/NUMBE'R <br /> <br />TOTAL ASSESSED FEFS <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />BALANCE DUE <br /> <br />REFUND DOE:UHENT <br /> <br />UNISSUED APF'LICATION 9047S01 <br /> <br />QUANTITY AMOUNT <br /> --$2.00 <br /> <br /> $0,80 <br /> <br /> OFFICE COPY <br />FORM It MC ~-~6 REV. 4/90 <br /> <br /> <br />