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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: 58S-5147 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 58847904 <br /> am gerforming work on a property, own or occupy, ~~..~ <br /> am a registered builder OR the authorized representative SIGNATURE OF APPLICANT; <br />of a raglstered builder, <br />The work will be pedormed by a registered builder, <br />Other , <br />I have read and agree to the terms stated on the reverse side of <br />this document, <br /> <br />', MA,.~CNKI:,,~ _ES & BI:ITY .RE. SIDENT~_ <br /> <br /> 1168f~ LARK CT NE ~ CONTRACT CITY: ]UGB; ~OOOUPANT LOAD'. <br /> AURORA OR 978~2 MARION COUNTY NO ; <br /> <br /> .... 81 N MENZIES DE <br /> PORTLAND~ OR 9~217 MOBILE 7~-t158 , SITE WUMBER: ~-B2G~5 ! <br /> PHONE: 28~-6~62 : VALUATION: <br /> <br /> '[~Y7 BL~E: GEt'ION: ?OWNSHIP; ~ RANGE: ~ ZONE: ~MAP: Ii <br /> <br /> [WIDTH;I ~ ,DEPTH; AREA ~ ~NITS;~S ............. ~,,..&iRR~ ................ LOT: "~ .... CO~[' [ -~ <br />............................ ¢ .......................................................................... ............... ....................................... <br /> <br />TYPE: ELECTRICAL <br /> <br />CONTRACTOR~ NO,, <br />LICENSE NO: <br />MACCHKE. LES & BETI'Y <br />~201N MENZIES DR <br />POR'FLAN~. OR 97217MOB~E:E79~Zl <br />PHONE: 289-6962 <br /> <br /> ITEM <br />MANUFACTURED HOME SERVICE/FEEDER ' ' <br />ELECTRIC, AL STATE ~URCHARGE , <br /> <br />PERMIT OR APPLICATION HO= 9848844 <br /> <br /> SUPERVISING ELECTRIC]AN/HUflBER <br /> <br />QUANTITY AHOUNT <br /> 1 $40.80 <br /> $2.08 <br /> <br /> · ECEIPT8 $0.00 <br /> $42.00 <br /> <br /> PA EE= MASC KE. UES ' <br /> RECEIPT NO~ 5~167 <br /> RECEIVED BY. PM _~ .... , TYPE:: CK CHECK ~: ~.400 <br /> ....... <br />ULLUWIN6 MUST BE APPLICANT TO ASSURE <br />ALL NECESSARY <br /> <br /> PLAN REVIEW: BY DATE ::;__ CITY::JURISDZ .I ]. ],1: BY I)ATE <br /> REMARKS: MS SEA ,: <br /> <br />rOF~M # aC ~s.~ Re,,,,~/,~ OFFICE COPY <br /> <br /> <br />