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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 pe(forming work on a property I own or <br /> <br />The work will be performed by a registered builder, <br />Other. <br />I have read and agree to the terms stated on the reverse side of DATE~ <br />this document, <br /> <br /> ................................ ~..4~2 &2=A7 ~ ...... RES <br /> <br /> 13793 EHLEN RD NE ~'~6fi~'~i+Y'. ........ ['fi~:- ........... ~6~duPA~'T <br /> AURORA OR 97~82 ~ARION COUNTY j"O <br />~W'5~-~',Z~] A~T ..................................................................................................... <br /> <br /> ...................................................................... . ~.~-~- ............................................ <br /> MAILING ADOREB~'. BU 8DIVISION; <br /> <br />PO BOX 875 <br />WIL, SONVII. LE OR 97078 SITE NUHBER: 94-82794 <br />PHONE: 694-5189 VALUATION: <br /> ~ A'fi-6~ --' ~7 ........... i ~A'¢;' ' <br /> ................ i , <br /> ~-- %~ .......................... <br /> <br />TYPE= ELECTRICAL PERflJT OR APPLICATION NO= 5661~ <br /> <br />CONTRACTOR, NO. <br />LICENSE NO: <br />HEWITT, DEL <br />PO BOX 875 <br />WIL. SONVILLE OR 9787~ <br />PHONE[: &94-5189 <br /> <br />SUPERVISING ELECTRICIAI~/NLIMBEE <br /> <br /> ITEM <br />SERVICE/FEE~)EE LESS <br />ELECTRICAL STATE <br /> <br />QUANTITY <br /> t <br /> <br />ANOUNT <br /> $50.00 <br /> $~.. 50 <br /> <br />$52.50 <br /> $0.00 <br />$52.50 <br /> <br />$8.88 <br /> <br />PAYEE: HEWITI'~ DEL <br />RECEIVED BY: PM <br /> <br />· , RECEIPT <br /> CA CHECK <br /> <br />91.4 <br /> <br /> ~ THIS IS A VALID <br />CONSTRUCT[OH CEASES FOR <br />REGUIREHENTS OF STATE <br />SHALL BECSHE NULL ANO <br /> <br />ISSUE DATE. IF <br /> <br />REMARKS: 188 AMP SER ~' <br /> <br />DONAI_I) E. WOODLEY, <br /> <br /> OFFICE COPY <br />~ORM # MO ~5-58 REV, 4/v~ <br /> <br /> <br />