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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 /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />i am a registered builder OR the authorized rec~resentative StGNATURE OF A , <br />of a registered builder, <br />The work will be ¢erformed by 8 registered builder, <br />Other <br />I have read and agree to the term8 stated on the reverse side of : <br />this document, <br /> <br /> CONTRACT CITY ; UGe IOCCUPANT LOA~: <br />m PHONE: 749-2394 VALUATION: <br /> <br />TYPE: ELECTRICAL <br /> <br />(;ONT,R~C'~"OR,, NO,. <br />LICENSEE <br /> <br />PERI4IT OR APPLICATION MO: 57117 <br /> <br /> SUPERVI SIbK; ELECTF(ICIAN/NLiMBER <br /> <br />PHONE,': 749-2394 <br /> <br /> ITEM <br />,SI";30VICE/Iq[EDER LESS l'bA~ 28~ A~:' <br />BRANCH C):RCU;[T., bJZ'i'H SERVICE OR F'EE~ER <br />EI.f~C'FI(ICAL STATE SURCHARGE <br /> <br />FAYEE. JALtxo <br /> <br />OTAL ASSESSED FEEo <br />PREVIOUS RECEIPTS <br />/HZS, RECEIP'T <br /> <br />QUAN'¥'IT~ AMOUNT <br />1 $50.00 <br />2 <br /> ¢2.70 <br /> <br />RECEIF'T NO: <br /> <br /> $0,,00 <br />$56.70 <br /> <br /> REIJ.;.]V~;D BY,~ DF' TYPE: 6K CHECK ~: 15:[8 <br /> $ THIS IS A VALID PERH'IT * .' 'TH~S. PERMIT E~IRES 188 DAYS FROM ITS ISSUE DATE. IF <br />CONSTRUCTION CEASES FOR A PERIOD ~QF..XO~ DAYS,. OR IF CONSTRUCTION FALLS TO MEET ALL <br />SHALL BECOME HULL AND VOID. ' , <br /> <br /> DONALD E, WOODi_EY~ MARIOh CO: ~TY BUILDING DF'Ft;IAL / BY <br /> <br /> OFFICE COPY <br />FORM # MC ~ 5-56 REV. <br /> <br /> <br />