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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STRC;ET 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 I own or occupy. <br />I am a registered builder OR the authorized representative <br />of a registered builder, <br />The work will be pedormed by a registered builder. <br />Other <br /> <br />I have read and agree to the terms stated on the reverse side of <br />this document, <br /> <br />.... DA'I'E-~ ... 10/.26/9;,~ ........ -T-It4_E:- I ]..]-) =-4~ ........................................................................... , ..................... <br /> ~WNE~: ...... F TAX LOT; ~ CATEGORY; <br /> NORTN M~RION ~CHOOL DISTR~CT ~(HHE. RCI~f,,. · <br /> <br />'sdua ~S: }-~6~dB'6~i6~ gg~ ........................... ~ ~Xh~-~: ............... <br /> <br /> 2~258 GRIM RD NE ;"ddh~'A~f'~i~¢~ ......... [-~o--~ .................... ~cZu~aT-Cd~6- .......... <br /> AURORA OR ~78~2 ,~MARION COUNTY NO ~ <br /> <br /> L <br />, ~%iL~'d ~¥~-n~S& ................................................................... T~58~V~l~ .................................................... <br /> <br /> SAME <br /> ~ SITE NUMBER: <br /> F'HONE: 982-~887 VALUATION: <br /> <br />~¢~ ............ T~Cb~R ............ ~'~¢[6~ ................. [~A ~ ........ %~%E~i .................. i~N'E7 ................. ~¢ ............. <br />~,f~: .................. ~ .............. %¥~ .................. ~[¢~; ............. ~ff~7 U6~ ..........Z~h~7 .................................. <br /> <br /> TYPE: ELECTRICAL PER~IT OR APPLICATION NO: 58~14 <br /> <br /> CONTR~CTOR, NO. 51161 SUPERVISING ELECTRICIAN/I~UMBER <br /> LICENSE NO: <br /> 8t78 60M~qu~ J,c at ~.ons <br /> 185 SE 1st <br /> Canby~ <br /> PHONE: <br /> <br /> tTEH QUANTITY <br /> SIGNAL CIRCUIT(S) OR LIH~TE~ ENERGY PANEL <br /> ELECTBZCAL STATE SURCHARGE <br /> <br />AMOUNT <br /> $40.00 <br /> $2.00 <br /> <br /> $42.00 <br /> $0,00 <br /> $42.00 <br /> <br /> TOTAb ASSESSED 'FEES <br /> PREVIOUS ~ECEtPT9 <br /> <br /> FAYEE. Cra bommunicat~ons Inc .: . RECEZPT NO:: 53327 <br /> RECEIVED BY: DM2 ......................................... ...... TYNE. CK CHECK $: 4~;34 <br /> <br />uNsl~u~TZO~ C£ASES FDR :A ;'~ERZBD.~,,OE;t.&00 ,'DA¥S~.,~'OE IF,~OHSTRUCTION FAILS TO ~EET ALL <br />REOU~REHENTS OF STATE LA~.:,AHD ~AR~ON'COUNTY;~UILDIN~,'~N~ ZBNIN6 ORD~HANCES~ THIS PERffZT <br />SHALL BECOME HULL AND VOID, <br /> <br />REMARKS: ALARM ~. <br />DONALD E. WOODLEY, MARION COUNTY BU2LDING OFFICIAl.. / BY <br /> <br />CORM # MC 15-58 REV, 4,~0 OF FICE COPY <br /> <br /> <br />