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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 />of ~ red,stewed builder, <br /> <br />[ have read and agree to the terms stated on the reverse side of DATE; ....... ~...~ _~ <br />this document· <br /> <br />¢ ...... ~B~_ ..................... ~__~Oe2" ~MARIO~ COUNTY NO <br /> <br /> ;~75 5TH ST <br /> PHONE~ 981-3~74 VALUATION: <br /> <br />TYPE= ELECTRICAL <br /> <br />CONTRACTOR~ NO. <br />LICENSE NO: <br />TAUTFEST, RUSSELL <br />~175 5TH ST <br />HUB~A,RD OR 97e32 <br />PHONE= 98~-3e74 <br /> <br />PERHIT OR APPLICATION HO= 9056179 <br /> <br /> SUPERVISING ELECTRICIAN/NUMBER <br /> <br />ITEM <br />SERVICE/FEEDER LESS THAN 200 AMPS <br />BRANCH CIRCUIT. WITH SERVIC~ OR FEEDER <br />ELECTRICAL STATE SURCHARGE ' " <br /> <br />PAYEE= TAUTFEST, RUSSELL <br />RECEIVED BY: PM <br /> <br />TOTAL ASSESSED'FEES <br />PREV'IOUSRECEIPT9 <br />THIS RECEIPT <br /> <br />QUANTITY ANOUNT <br />1 $50.00 <br />1 $2.80 <br /> <br />$54.68 <br /> $0.80 <br /> <br />BALANCE DUE $0.00 <br /> <br />RECEIPT ilO: 58674 <br /> <br />...... .._. ~ ~ _ ..... TYPE: CK CHECK ~: 2118 <br />F_~_~M~_I~. ~T_~ ~F-~..~IT..THIS APPLICATION HUST r~o THROLI~H'A RE'VIE~ PROCESS ~HERE THE <br /> ULLUUZHb MUSl BE CUNPLETED." IT IS.~HE' RESPO~ILZTY OF THE APPLICANT TO ASSURE THAT <br /> <br /> REH~EKS= 2ee ~p svc/ ~ cZR ' ' ' ' ' <br /> <br /> OFFICE COPY <br />~ORM # MC 16-~$ REv', 4)90 <br /> <br /> <br />