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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 performing work on a property l own or occupy, <br />I am a registered builder OR ) the authorized representative <br />of a registered duitder. <br />The work will be performed by a registered builder. <br />Other <br /> <br />1)ATE;; ,1,~)/29/9;~ 'T'INE'.,~ Sc,,,'.,,~ ,,=,",, ') <br /> <br /> ~i:fD'~ A[YD~Essf ...................................................... J!-CO~§¥~u'O'rldN TYP6; ............ <br /> ~ - -, ....~¢ r ' <br /> <br /> 2132 N~T~ON~L CT SE ~ ................................................................ <br /> PHONE~ ',~64,,,,5458 ~ VALUAT ]'.ON~ <br /> <br /> "~L~8-RT 3~f6fl; ~E¢~ 'i ¢'~'~ <br /> <br />.................... ............... 5 .................. ............... } ............. ................ <br /> <br />TYPE: ELECTRICAL <br /> <br />CONTRACTOR, NO,, <br />LIBENSE <br />~OHNSON. B~LLY 6 <br />2132 NATIONAL C'T SE <br />SALEM~ O~ <br />PHOI,IE~ ~64-5458 <br /> <br />PERMIT OR APPLICATION NO: 9l~51~,~6 <br /> <br /> ,SUP ER¥,[SING ELEC TR ;( C :~ AN/NIJFF[~ER <br /> <br /> ITEM <br />MANUFACTUEE~ NOME SERVICE/FEEDE]~ <br />ELEC'IEICAL STATE ~URCNARGE <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THZ~ RECEIPT <br /> <br />QUANTITY AHOUNT <br /> $2,,00 <br /> <br />$ 9 <br /> 4~.o0 <br /> <br />-. BALANCE DUE ~;0.00 <br /> <br /> PAYEE:J JOHNSON, BILLY G RECEIPT NO: <br /> RECE]:VED BY: P~ ..................................... = ............. TYI E. CE [,HELl( ~: 3729 <br /> <br /> ~ THIS IS NOT A PERMIT. THISAPP~ICATIOHTHUST GO,THROUGH A REVIE~ PROCESS WHERE THE <br />FOLLO~[H~ HUST ~E COHPLETE~., ,IF IS THE",RESPOHSI~L[TY OF THE APPLICANT TO ASSURE THAT <br />ALL HECESSARY INFORH~TIOH H&SDEEN, PROVI~ED. <br /> <br />PLAN REVIEW: BY .............. DATE ................ <br />REMARKS: i'lS SER <br /> <br />PO,~ # ~c*~.~ R~v, 4~ OFFICE COPY <br /> <br /> <br />