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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 />t am performing work on 8 property I own or occupy. <br />I am a registered builder OR the 8u horl~ed rep esen a ye <br />of a reglstered builder, <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 <br />this document. <br /> <br />f~U.].~ E;T~ ~xOao~.[J .............. ¢ ............. <br /> Z1371 FAR¢O RD NE [ CONTRACT CITY; i UGB'. ~OCCUPANT LOAD; <br /> <br /> SITE NUMBER: <br /> IF']~ONE: 678-2169 ~ VALUATION: <br /> <br />TYPE: ELECTRICAL <br /> <br />CONTRACTOR, NO. <br />Li[,ENSg NO,, <br />'FAUT'FEST, RUSSELL <br /> <br />PERMIT OR APPLICATION NO: 56179 <br /> <br /> SUPERVISING ELECTRICIAN/NIJNBER <br /> <br />PHONE: /~78.-.2'1,69 <br /> <br /> ITEH QUANTITY AHf]UNT <br />SERViCE/FEEDER LESS THAN 288 AMPS 1 $5~,,~ <br />BRANCH CZRCUIT~ W~TH SERVICE OR FEEDER i $2.80 <br />ELECTRICAL STATE SURCHARGE $2.58 <br /> <br />PAYEE: <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEI, PTS <br />THIS RECEIPT <br /> <br />$54.50 <br />$54,,60 <br /> $0.00 <br /> <br />BALANCE DUE $0.00 <br /> <br />RECEIPT NO: <br /> <br /> Rf-EOEIVED BY: DM TYPE: CHEEK ~: 0 <br /> <br /> A THIS IS A VALID PERHIT.~. THIS PERHII EXPIRES 188 DAYS FROH ITS ISSUE DATE. IF <br /> <br />SHALL DEC,HE NULL AN9 <br /> <br />REMARKS I <br /> <br />I)ONAI,,b E,, <br /> <br />208 AMP S¥C/ I <br /> <br /> WOODLEY~ MARLO',! COt, ,TY BUILD'rNG OFFICIAL / DY <br /> <br />OFFICE COPY <br /> <br /> <br />