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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 prrfo ming work on a property I own or oocvpy, <br />t em a regis ered bulder OR he au hot zed represen ave <br /> of a registered builder. <br />The work w~ll be performed by a rogistored builder, <br />Other. <br />I have read and agree ~o the terms stated on the reverse side of <br />this do~,um Ont. <br /> <br />SITUS ADDRESS'. ; CONSTRUCTION TYPE; OCCUPANCY: <br /> <br /> 8900 MILL CREEK ROAI) __ :CONTRACT CITY; UG8: ;OCCUPANT LEA[;): <br /> <br /> ' AUMSVILLE OR ?7325 iAUMSVILLE NO ~ <br /> <br /> ! SITE NUMBER: 74-~t2473 <br /> PHONE: 508--5~4 ~ VALUATION: <br /> <br />,LOT; BLOCK: : SECTION'. TOWNSH P RANGE; i ZONE; MAP: <br /> <br />TYPE: ELECTRICAL <br /> <br />COI,ITRACTOR~ hi(). <br />LTCENSE NO: <br /> Judsons Inc <br />PO Box 12&&? <br />Salem, 97;509-0000 <br />PNONE: 363-4141 <br /> <br /> ITEH <br /> <br />PERMIT OR APPLICATION ND: 5683';' <br /> <br /> SUPERVISING ELECTRICIAN/NUMBER <br /> <br />BRANCH CIRCUIT~ WITHOUT SERVICE OR FEEDER - 1ST CIRCUIT <br />BRA~CH CIRCUIT. WITHOUT SERVICE OR FEE~ER ~ EACH ADDITIONAL <br />ELECTRICAl. STATE SURCHARGE <br /> <br /> TOTAL ASSESSED:FEES <br /> PREVtOU8 RECEIPTS <br /> <br />QUANTITY AMOUNT <br />1 $35.00 <br />1 $2.00 <br /> $1.85 <br /> <br />PAYEE: Judsons Znc' <br />RECEIYE9 BY: MB <br /> <br /> ~ THIS IS A VALID <br />CONSTRUCTION CEASES FOR A <br />REQUIREMENTS OF' STATE LAWS <br />SHALL BECOHE NULL AND VOID. <br /> <br />RE:MARKS~ 2/CIR <br /> <br />$38.8,":; <br /> $0,, 80 <br />$38.85 <br /> <br />$8.00 <br /> <br /> CK CNECK ,~: 6013 <br />Explr:RES 180 BAYs FROM ITS ISSUE DATE. iF <br /> UR IF CONSTRUCTION FAILS TO MEET ALL <br /> lNG AND ZONINg ORI)INANCE$, THIS PERMIT <br /> <br />~)ONAt,,.~) E., <br /> <br />MARION COUNTY BUILJ~IN6 OFFICIAL / BY <br /> <br /> OFFICE COPY <br />FORM # MC 15-56 REV, 4/90 <br /> <br /> <br />