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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 225 <br />2'2'0 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 I own or occupy, <br /> ~ am 8 registered builder OR the authorized representative <br /> ct a registered builder, <br /> The work will be performed by a (eSiste¢ed builder. <br /> Other <br /> I have read and agree to the terms stated on the reverse side of <br /> this documem, <br /> <br /> 05/17.~/94 TIME:. ,1.2:07:47 <br />OWNER'. ~Ax LOT: CATEGORY; <br /> ,J4ITH, JANES AI.LEN : :RESIDENTIAL <br />SITUS ADDRESS; ' GONST~gCf~ON "¢YP~i , OCCUPANCY; <br /> <br /> ;1:,?,470 I,.AKEWOOD DR NE <br />AtJRORA OR 970~2 <br /> <br /> L~KEWDOD ES~TES NO 1 <br /> <br /> ~ SITE NUMBER: 94-~1868 <br />PHONE= &78-[45~ <br /> <br /> ~ RS , 5 <br /> ~8 L 29~ ~ SF YES ~ NO <br /> <br />LOAD: <br /> <br />TYPE: ELECTRICAL <br /> <br />CONTRACTOR, NO. <br />LICENSE <br />SMITH~ JAMES ALLEN <br /> <br />SUPERVISING EL. ECTRICIAM/NU~BER <br /> <br />PHONE~ 678-1458 <br /> <br /> I'rEM <br />BRANCN CIRCUIT, WITMOUT SERVICE OR FEEDER - l$'r CIRCUIT <br />ELECTRICAL STATE SCRCHARGE <br /> <br /> TOTAL ASSESSED FEES <br /> PREVIOUS RECEIPTS <br /> THIS'RECEIPT <br /> <br />QUANTITY AMOIJNT <br /> ;L $35.00 <br /> $I.,75 <br /> <br />Sa6.,7w <br /> <br />$36.75 <br /> <br /> PA!EE~ S~ITH, JAMES :: RECEIPT NO: 574~1 <br /> RECEIVED BY: c12 TYPE: CK CHECK ~P: 1618 <br /> * THIS IS NOT A PERHI[~ THROUGH A REViEM PROCESS ~HERE THE <br />FOLLOWIHG MUST BE CDflPLETED, ,IT',,IS:,THERE;SPOMSiBZLITYOF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY iNFORMATION HA~:SEENPRO¥I~9, <br /> <br /> PLAIq REVIE~ BY .......... D~TE~_w_2~ .... ~:~ gITY dURISD~gTI~Iq: BY .............. ~ATE .................... <br /> REMARKS: 1ClR FOR ADDITION <br /> <br />FORM # MC ~-,~ R~, m~ OF FICE COPY <br /> <br /> <br />