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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: 588-5147 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />~'~ I am a registered builder OR ( ) the e, uthorized rel3resentative $ GNATURE OF AP~LICAN <br /> of a registered builder. <br /> <br /> Other <br /> I have read and agree to the term8 stated on the reverse side of DATE;.__~_/~ <br /> this document, <br /> <br /> AUitSVILI,,,E [IR ?325 MAF;']:E]N COUNTY [ NO l <br /> T ................................................................................................................. - ........ ...... <br /> , ............. <br /> <br /> OTAYTOhl OR ?~38~ ~K~'78-.,8486 [ ~ITE NUMBER: ~4-~22~ <br /> PHONE:: 747'-2~92 ~ VAI,.UATIQN~ <br /> <br /> 3e:l. j 727 [ 218827. j [~r } I~ ~ NO ..... <br /> <br />TYPE: ELECTRICAL <br /> <br /> COI',I';rl;~ACTOR ~ ]'40, <br /> LICENSE NO: <br /> flAUoCH~.E,~ NORHAM & CAROL <br /> <br /> STAYTON 0R 9738'Z <br /> PHONE: 769.,.,2~9~ ,, <br /> <br /> ITEM ,:, <br /> SERVIE, E~I"rEE~ER LESS, 'ff~AN 2Bg, AMPS <br /> BRA~C- .l~CJIf,, WITt SERVZ.6E OR FEEDER": · <br /> E,.ECTR]:CAL STATE ~ <br /> <br /> ~AYEE: RAU[~CHER,~ <br /> RECE]:VEI) BY; HB <br /> <br /> ~ THIS IS NOT A PER~I! <br />FOLLOWING HOST BE <br />ALL NECESSARY INFORMATION: <br /> <br />PERMIT OR APPLICATION NO: 9~52;~22 <br /> <br /> SUPERVISING ELE'CT R I C t AF!/i,IUHOE';.;: <br /> <br />REI'~ARKS; <br /> <br />$56.7~ <br /> $~,,0~ <br />$56,,70 <br /> <br />RF,,:CI: I PT NO:: 54777 <br />CHECK ~: 250 <br /> <br />REVIEW PROCESS WHERE THE <br /> APPLICANT TO ASSURE THaT <br /> <br /> ~C'F]:ON:i BY ....................... DA'T'E ................ <br />:L/FEEDER ,~,,/C I R <br /> <br />FORM # Mc 15.56 RE'V, 4190 <br /> <br />OFFICE COPY <br /> <br /> <br />