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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 b~iI~er OR ( ) the authorized representative SI~N.~TURE O~ APPI. CANT. .................................... <br /> <br /> Other <br /> <br /> this document, <br /> <br /> ' COBB,~ RICHARD ~ RESIDENTIAL <br /> <br />MAI~ING ADDRESS: SUbDIViSiON; <br /> CENTURY <br /> <br />3528 MAPLE STREET <br />HUBBARD 97032 DAYTIME 684~4280 SUE <br />PHONE: 981-8168 <br /> <br />SITENUMBER= <br />VALUATION: <br /> <br />TYPE: ELECTRICAL <br /> <br />CONTRACTOR~ NO. <br />LICENSE NO: <br />COBB~ RICHARD <br />3520 MAPLE STREET <br />HUBBARD 97032 DAYTIME <br />PHONE: ~81-8160 <br /> <br /> ITEM <br />MANUPACTURED HOME 8ER~: <br />ELECTRICAL STATE SURCHARI <br /> <br />PERMI1 OR APPLICATION HO: 9~§1166 <br /> <br /> SUPERVISING ELECTRICIAN/NUMBER <br /> <br /> PAYEE. COBB~ RICHARD <br /> RECEIVED BY: DM2 <br /> <br /> /~ THIS IS NOT A <br />Ff3LLi3~ING NUGT <br />ALL NECESSARY INFORHATIO <br /> <br />QUANTITY AMOUNT <br /> I $48.88 <br /> $2.88 <br /> <br />$42.80 <br /> <br />$42.88 <br /> <br />$8.88 <br /> <br />RECEIPT NO: 53584 <br />CE CHECK ,f: 487 <br /> <br />PROCESS WHERE THE <br />;ANT TO ASSURE THAT <br /> <br />PLAN REVIEW: BY <br /> <br />REMARKS: M{~ SERVICE <br /> <br />~ATE <br /> <br />FOR~ # Mo ~s-~ ~, 4/eo OFFICE COPY <br /> <br /> <br />