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MARION COUNTRY BUILDING INSPECTION <br />SENATfDR BLD,G. NO, 225 <br />220 H'~i S~REET 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 performing work on 8 property I owr/ or Occupy. <br />lamareg~steredbuiiderOR( ) the authorized representative <br />of s registered builder, <br />The work will be pedormed by a registered builder. <br />Other <br />J have read and agree to the terms stated on the reverse side of <br /> <br />14071 ARHDT RD FIE <br />A, tJ~£1RA,,~ OR 97002 <br />PHONF',~ 6'Y8'- 12~2 <br /> <br />SiTE NU~IBER: 74-84281 <br />VALUATION: <br /> <br />TYPE: ELECTRICAL PER~IT ~R APPLICATION NO= 59278 <br /> <br />COI,ITRACTOR~ NO, 26071 <br />LICENSE NO: <br /> C;mby E].ec~ric Inc [~o~¢t,~_~ <br />7%~ S ivy St <br />~abby~ 9701.,~-oe00 <br />FHONE: 266-7878 <br /> <br />SF, R¥ICE/FEI--"I)ER LESS THAN 20~ AMPS <br />BRANI;I~ CIRCLI.[T,, (~IT~ SEEV/CE [IR <br />ELECTRICAL STATE S[JRCHARGE <br /> <br />SUPERVISING ELECTRICIAN/NUH~ER <br /> <br /> AMOUNT <br /> ~100.0~ <br /> $4..00 <br /> <br /> !~109,,~,0 <br /> $0.00 <br /> $109.20 <br /> <br /> $0.80 <br />~ F~EC[ZPT hO: <br />OK 6HECI( ~= 17027 <br /> <br /> EON ITS ISSUE 9ATE. IF <br /> TiQN FAILS TO ~EET ALL <br /> ~IN~ ORDINANCES, THIS PERMIT <br /> <br />FORM # MO 15-58 REV. 4/~0 OFFICE COPY <br /> <br /> <br />