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MARION COUNTY BUILDING INSPECTION
<br />SENATOR BLDG. NO. 2~$
<br />220 HiGH STREET Nr:
<br /> SALEM, OREGON 97301
<br />
<br /> PHONE: 588-5147 8:00 - 4:30
<br /> ,~_ 24 HOUR CODE-A-PHONE: 588-7904
<br />
<br />I em performing work on a property I own or
<br />I am a registered builder OR ( ) the authorized representative SIGNATURE OF APPLICANTZ
<br />of a registered builder.
<br />The work wilt be performed by a registered builder,
<br />Other
<br />I Save read and agree to the terms stated on the reverse side of DATE:
<br />this document.
<br />
<br />bwhE~;
<br />
<br />~if5~ ACd~SSl
<br />
<br />TAX LOT:
<br /> 4:L838,,,.800
<br />CONSTrUCtION TYPE:
<br />
<br />, CATEGORY:
<br />: RESZDE'"~AL_
<br />: OCCUPANCY~
<br />
<br />CONTRACT CITY: ~ UGB: ;OCCUPANT LOAD:
<br /> NO 0F BEOROOMS
<br />
<br />MAILING ADDRESS: [ SUBDIVISION;
<br />
<br />VAi,,,UAT ZON:
<br />
<br /> , , / '~ ' 48 2W : EF'U
<br />WIDTH; DEPTH; ! AREA: UNITS; ' tRRE~. LOT: ' CORNER:
<br /> I ,58. ! AC; i Y F,,,O : NO
<br />
<br /> TYPE: ELECTRICAL P£RHIT OR APPLICATION NO: 54224
<br />
<br />Ot')i~TR,A,C ]Z)R ~ Fill)., 97782
<br />[_:]:(,EP, SE Nf_t:
<br />HORSE .,.I,,.ECT~ ~ C
<br />601 SE 8TH 8'1
<br />6RANOS F AS~. 97m~6
<br />Pi, lONE: 4'76,-, 14~'~?
<br />
<br />R,t'.S WIRING ( 108(~ SQUARE FE[;T
<br />SERVICE/FEEDER .ESS THAN 20~¢~ AMPS
<br />Ei.b. CTRIC~L STAI!~ StJRC].~ARGF
<br />
<br />StJPElr<V l S];N~ ELEC'FR ]:C I AN/NUMBE!:/
<br />
<br />QUANT I TY bani Ud'r
<br />
<br /> ~: 50 ,. ,',.',' f)
<br /> $6,, 75
<br />
<br />TOTAl.,. ASSESSE~ FEES
<br />PRE'~ l gU ~ RECE]:PTS
<br />THIS RECEIPT
<br />
<br />$14;t,. 75
<br /> $0 ,, O(i.i
<br />$141.75
<br />
<br />BALANCE DUE $~¢. 00
<br />
<br />FAYE:.: FIO!;~SE gl,..:,,TR If;, P, ECF'tPT NO: 56692
<br />l,d;]()K:f;VE,f) BY: CI_ TYF'E: CA C[-'}E(]J~, ~': ~
<br />
<br /> * THIS IS A VALID PERMIT , TH~S,PERMIT,EXPIRES 188 ~AYS FROH ITS ISSUE DATE. IF
<br />COESTR~CTION CEASES FOR A PERIOD OF [8~ DAYS~ OR IF COHSTRUCT[~H FAILS TO HEET ALL
<br />RE~U~,~E~E~T~ OF STAT~ LA~S A~D fl~Z~ COUNTY BUiLDZNG
<br />SHALL BECOHE HULL ANB VOID.
<br />
<br />RKFiARt(S~ RES g'EWIRE & S¥C (OI'?D APPL =EE: ON ':~ SVC'~ FEES ~IY
<br />
<br />l)l;ll'l~;._J!) E,, (dl]i.;I)l..~Ey 4 - ' (iV
<br />~,~'(Oh t;O(]I,ITY ?i~[j)it. Di.r,~!f~, OFF'OCTAL / BY ...........................................................
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<br />FORM ~ MD t~-f6 REV, 4/0~ OF FICE COPY
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