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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 />l am a registered builder OR ( }theauthorlzedrepresentative <br /> <br />I have read and agree to the terms stated ou the reverse side of <br />this document, <br /> <br />SIGNATURE OF APPLICANT; <br /> <br />TE: ~1':t/2+/04 T''tME:~ .... L~)l': : ~ATEGORY'. <br /> <br /> 5458 DUHORE DR SE ~O00UPANT LOAD: <br /> AUMSVILLE OR 97~25 ~,MARION COUNTY ~ NO <br /> <br /> F'HOblE ~ 58S-2~64 VALUATION: <br /> <br />TYPE: ELECTRZCAL <br /> <br />CONTRACTOR~ NO. <br />LICENSE NO: <br />RUDISHAUSER~ RICK <br /> <br />PERMIT OR APPLICATION 'NB:: <br /> <br />SUPERVISIN~ ELECTRICIAN/NUMBER <br /> <br /> PHONE: 585-2664 <br /> <br /> ITEM QUANTITY AMOUNT <br /> SERVICE/F~EDER LESS THAN 2B0 AMPS : i $§0.00 <br /> BRA~CH CIRCUIT. WITH SERVICE OR FEEDER 3 $6.00 <br /> ELEI, TRICAL STATE SURCHARGE ~:. : $2.80 <br /> TOTALA~CE$$ED F~ES $58.88 <br /> $~8.80 <br /> PRE:Vt~USRECEIPTG <br /> $o.00 <br /> A A cE; <br /> E $0.00 <br /> PAYEE: <br /> RECEIPT NO: <br /> <br />$ THIS I~ A VALI~ PERNIT~THI,S PE~ITE~RE~:~:i18~DAys FRON ITS iSSUE DATE. IF <br />CONSTRUCTION CEASES FOR A,PERIODOF ':ZSCDAYS;OR:IFCONSTRUCTION FAILS TO NEET ALL <br />FFEOUZREHEHTS OF STATE LA~S ANDHARZON COUNTY,BU~HG AN~ ZONING ORDZNANCES~ THIS PERMIT <br />SHALL ~ECONE NULL AN~ VOID, ' <br /> <br /> REMARKS: <br /> <br />DONALD E. WOODL. EY, MARION COUNTY BUILDING OFFICI~ij / BY <br /> <br /> OFF~CE COPY <br />FORM # MC 15-56 REV, 4/9O <br /> <br /> <br />