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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 225 <br />220 HIG'H STREET NE <br /> SA'LEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />lamareglsteredb¢lderOR( ) the authorized representative <br /> <br />CONTRACT CITY: i UGB; i OOCUPAHT LOAD: <br /> <br />TYPE:= ELECTRICAL <br /> <br />t,,.,1. ,F,, I,,~E <br /> <br />PO ~ox 37,5 <br /> <br />SENVI~.k/F~r,E~ER L.E~S tHAN 2~¢: A~I,.'S <br />ELECTRICAL 3TATE <br /> <br />PERt'fIT ORi APPLICATION NO: 9054721 <br /> <br /> St_F E,WI~IIIG LL.EC f'kICt AN/I f~JME ~R <br /> <br />?o'rAL ASSESSEID FEE'S <br />PREVTOU8 RECETpT,,S <br /> <br /> A, I ..... RECEIPT <br /> i,~E,(,.~:~IV[;.I) FJY: CL . ................. : ................ J..::;..:,~;.~_.:_~_,_,__ ............. TYPI'-'= CH~:;LI~ '~; 0 <br /> <br /> ~ THIS IS NOT A PERMIT, ~PPEICAT~ON ;HUST 60 THROUGH A REVIEW PROCESS WHERE THE <br />FOt,LOWIN§ MUST BE COMPLEI'ED;i, IT~I[S THE ' EE~PONSIImILIT¥ OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFORNATIOH 'HAS ~EEN PROVIDE]), <br /> <br /> ~, ...................... <br /> <br />FORM # MC 10-65 REV, 4~0 OFFICE COPY <br /> <br /> <br />