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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;80 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am performing work on a property t own or occupy. <br />I am a re~istered builder OR ) the authorized resresentative <br />of a registered builder, <br />The work will be per¢ormed by a re~istered builder, <br />Other_ <br /> <br />I have read and agree to the terms stated on the reverse side of <br />this document. <br /> <br />j'DW~E'~:'D'ATE; '05709794 I':(HE~ ~ .... ~T~ LO~: CATEGORY: <br /> WZLFI~]:ED~ WILKES <br /> <br />' 2~178 CASE R9 NE <br /> <br />;MAILING ADDRESS; , SUBDIVISION; <br /> <br />TYPE: ELECTRICAL <br /> <br />CONTRACTOR?, NO. 97702 <br />LIOEHSE NO. <br />HORSE ELECTR:rC <br />~,e:l. SE 8'm s'r , <br />6RAH~S PASS~ 97526 <br />PHOHE: 476-1499 <br /> <br /> II'E~ <br />SERVICE/FEEDER LESS T~AN 28~ A~PS <br />BRAHCH ~IRCUIT~ WITH SERVICE O~ FEE~ER <br />Et. EOT~[[,AL STATE SIJR~HARGE ; <br /> <br />PERHtT OR APPLICATION NO: 90548~4 <br /> <br /> ~UF ERV,[SING ELECTRIC]iAN/NUHBER <br /> <br />QUANTITY AMOUNT <br />1 S50.00 <br />1 $2.00 <br /> $2,, 60 <br /> <br /> TOTAL ASSESSEB FEES $54.,&0 <br /> PR~V'IOUS RECEIBTS~ $8.00 <br /> THIS RECEIPT $54.60 <br /> BALANCE DUE $0.00 <br /> <br /> RECEIYE9 BY. HB TYPE: CK CHECK ~:: 10 <br /> <br /> * THIS IS NOT A PERHIT. ~UST GO THROUGH A REVIEW PROCESS ~ERE THE <br />F9LLOWING MUST BE CDMPLETEDg:IT;IS :THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />ALL ~ECESSARY INFORMATION <br /> <br /> PLAN RE¥1E~: ~Y <br /> <br /> R~NflRK~: 200 S~RV <br /> <br />FORM # MC 15-56 REV, 4PJO OFFICE COPY <br /> <br /> <br />