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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 /> <br />I gm performing WOrk on ~ proper y own or occupy <br />I am a registered builder OR { ) the authorized representative SIGNATURE OF APPLICANT; <br />of a registered builder, <br />The work will be performed by a registered builder. <br />Other <br />I flare read and agree to the terms stated on the reverse side of CATE'. <br /> <br /> SITUS AD~R~ *~'~O~EI;~F CONeTRUCTION TYPE: i ~A~'.;- ?::~ .......f I ~ .. <br /> i i <br /> '. CONTRACT CITY; I UGB: ~OCOUPANT LOAO: <br /> <br />iUSE OF ~U/LDfNG: NO OF <br /> <br /> S4HE <br /> ~ S2TE NUMBER: 94-a~22~ <br /> I::'HdNE~ 3~,4-~,2.,.~ WK VAi_UATION~ <br /> <br />TYPE: ELECTRICAL <br /> <br />COH I I-~AC ¥OR.~ HO,, <br />L ICE:NS,E NO: <br />0 SOl% ROBERT <br />,,~APiE <br /> <br />PHOI,IE~ ;364,.,22:1.,6 NK <br /> <br />PERNIT ORi APPLICATION NO: 57471 <br /> <br /> SUPERVISIN~ ELECTRICIAN/NUHBER <br /> <br /> ITEM <br />SERVI'CE/FEEDFR LESS I'HAN 200 AMPS <br />[;, ,,El, rI,,] Cell STAI'E SI, ~,CHARGF' <br /> <br />QUANTITY A MO Ui't '~- <br /> .I. 0,, ~/ <br /> <br /> TOTAL ASSESSE.O FEES ~.,.~.,,50 <br /> PREVIOUS NECEIPTo <br /> <br /> BALANCE ~DUE <br /> ~AYEE¢; O[.SON~ RF~BERT RECEIPT HO= <br /> RECEIVI~:,I) BY: l)F ........................................................ TYPE:: CE CHECK ,~: <br /> <br />CONSTRUCTION CEASES FOR ,A PERIO~ ;OF 188 ~AYS~ O~ IF CONSTRUCTION FAILS TO ~EET ALL <br />REBU[REHENTS OF ~TATE LAflS AH~ ~RION COUHTY ~UILgING AN9 ZONING ORgINANCES THIS 'PC <br />SHALL BECOHE HULL AN~ VO'I~. ,' : ,,,, . ~ R~T <br /> <br />OFFICE COPY <br /> <br /> <br />