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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 />HOUR CODE-A-PHONE: 588-7904 <br /> <br />have read and agree to ,h, teems stated on the reverse <br /> <br />i OWNE":DAI'E; :t(4127/94 T i Hl~%" 1~: 18~ 5}. I TAX LOT~ <br /> <br />TYPE: ELECTRICAL <br /> <br />CONTRACTOR~ <br />LICENSE NO: <br />RIJDISHAUSEI% <br /> <br />PERMIT OR APPLICATION NO: 9859232 <br /> <br /> SUPERVISING ELECTRICIAN/NUMBER <br /> <br /> PHOHE r, 585-2664 <br /> <br /> ITEM QUANTITY AHOUNT <br /> SERV,~,CE/F'EE~).F_,~ LIESo TI4~N ~,~B AM,.S : 1 <br /> BRA~bH ~IRCUIT, W~TH SERVICE OR FEEl)ER <br /> ELECI'RICAL of Al'E SURCHARGE : $2,,fl~ <br /> <br /> :TOTAL, ASSESSE~ FEES $58. <br /> P~EVzous r~EC~Z,PTS Se. <br /> <br /> PA~EE~ RU~ISHAIJSER_ R~( , RECEIPT NO: 61814 <br /> <br />~LL NECESSARY INFDRH~TZDN HAS ~EEN PR~VI~, ' <br /> <br /> PLAN REVZEbI~ BY .................. ATE cITYZ JURIS3tCTION: BY DATE <br /> Rb, HARKS. SERV/~/CIR <br /> <br />Fo~ # Mc ~s-s~ Rev, ,V~ OFFICE COPY <br /> <br /> <br />