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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 ( ) ~he authorized representAbve SIGNATURE OF APPLICANT:. <br />Other <br /> <br />'~i¥0~"~DD'~; I CONSTRUCTION TYPE: I OCCUPANCY; <br /> Et J S,]" ANDF;:RS[}N' RI) .. SE . ~ ' ~ .' I <br /> <br />TYPE: ELECTRICAL P~RMZ'T OB APPLICATION ND: ?052109 <br /> <br />PA'(E:!E: WAi,.Z~ <br />,_[ L / ,D ~ <br /> <br />C~UAN'I :['f'Y A~I: I.H,!T <br /> <br /> 5 $ ~. 0 ,. ~,.?_, <br /> $2,. 25 <br /> <br />JANES P,, ~ CAROLYN S%'. ~/ h:ECE:J:PT NO,~ 54562 <br />Df't2 -~ TYF'E~' C!'; C'-.IE'~C,[~ ~: 99¢ <br /> <br /> $ THIS IS NOT A PER~tT. THIS APPL!CAT~ON MUST ~ THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING ~UST BE COMPLETED. ZT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSU~E THAT <br />ALL NECESSARY INFORMATION NAS BEEN PROVIDED, <br /> <br />F'I_.¢,N REV]]E/4: BY <br /> <br />........... DA'IE ................................... <br /> <br />C:[TY JL~R..S. DI(,,I L(,N,, BY ...................... DA'rE ..................... <br /> <br />!:(ii: i'h:~ R;'~ S r, 6 <br /> <br />FORM # UC 15.5~ REV. 4/90 OFFICE COPY <br /> <br /> <br />