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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 />of a registered builder, <br />The wock will be performed by a registered builder. <br /> <br />SIGNATURE OF APPLICANT: <br /> <br />57786-¢00 <br /> <br />CATEGORY'. <br />CS~MERC];AL <br />OCCUPANCY: <br /> <br /> (~/.itfiSVlL. L F; OR 97325 ,ALNSVTLLE ~ NO <br /> <br /> SITE NU~BER: 94-g~928 <br /> PHON~ 7~9-"2872 VALUATION= <br /> <br />, 1:[54 ~ 769 ~ ~74~6. ~ SF' ~ NO NO <br /> <br />TYPE: ELECTRICAL <br /> <br />COK'I-RACTOF:., NO. 91668 <br />L~.CENSE NO~ <br />CHERRY C:[TY E:L,I~CTR]f:C <br />P.d, BOX 12668 <br /> <br />PERMIT OR APPLTCAT'JON NO: 5748§ <br /> <br /> SLF[! -,VIS] N(., ELEC"~'R.~C:[AI,I/NUH~ER <br /> <br /> .TTEH <br />BRAt,ICH -~,R[;I,J]"I'~ WI]'HOI.JT S£--]"~V!CE OR FEEDER - 1ST <br />E,..EC, TI,(.ICAL STATE SURCHARGE <br /> <br />QUANTITY AMOUNT <br /> i $35.00 <br /> $I, 75 <br /> <br /> TOTAL ASSESSED FEES <br /> PREVIOUS RECE;[F'T(; $0.00 <br /> THIS RECETPT $36.75 <br /> BA[,,ANgE DUE' <br /> <br />68H~TRUSTZ~N CEASES FOR ~ :PE~O~ CF ~8¢ ~fS~ '~E iF 68NDT~UCT2~H F~[LS fO ~EET ~LL <br />EEBUZRE~EHTD OF STATE LR~S: ~HD H~R[DH 6OUETY BUZLDZH6 ~HD ZON[H~ 8EDZNBNBES THIS PE~ <br />SHBLL DEC~E NULL ~D VOID, , ~ H~T <br /> <br /> RF?,I'~RKS= ~R CZR ~/0 <br /> <br />DONf'tL.t) [!:,, WOODLEY,~ ?1AI:;;ION CSUN]'Y DtJILDING OFFICIAL / BY <br /> <br /> OFFICE COPY <br />FORM # MC ~ B-~8 REV, 4/90 <br /> <br /> <br />