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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG,..NO, 225 <br />220 HIGFI;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 />I am performing work Cfi a property I own or occupy A~T~~ ~ <br />I am a registered builder OR the authorized representa ive SIGNAYUI~E OF APPL~C <br />of a regis ered bu der, <br />The work will be perCormed by a registered builder. <br />Other <br />I have read and agree to the terms stated on the reverse side of DATE; <br />this document, <br /> <br />: dw~E~ATE: t 0/0~;/'¢'4 T I ME ,'~ ;I;'3.'-34." 59 .............. rTAk L6Y; j 6ATEeO~W <br /> <br /> L ...................... r ......... ~ 6~88~Z~f L~A9,. <br /> 62~ 5TH STREET __ CONT~AOY OmrY,. <br /> AUMSVILLE OR 97325 AUMSVILLE ~NO <br /> <br /> ~ITE NUHBER: <br /> PHONE: 749-2~52 ~ VALUATION: <br /> <br />TYPE= ELECTRICAL <br /> <br />CONTRACTOR, NO~ 03964 <br />LICENSE NO: <br />John A 8peer · <br />10764 Mill Creek Rd <br /> <br />PHONE: 749-2971 <br /> <br />PEI~iT ~ APPLICATION HO: 5862B <br /> <br /> SOPERVI$ING ELECTRICIAN/NUMBER <br /> <br /> ITEM <br />SERViCE/FEEDER LESS THAN 200 AMPS <br />BRANCH CIRCUIT. WITH SERVICE OR FEEDER <br />ELECTRICAL STATE SURCNARGE <br /> <br />PAYEE: JACKS ELECTRIC <br /> <br />TOTAL ASSESSED FEES <br />PREVIOU~ RECEIPTS <br />THIS RECEIPT <br /> <br />BALANCE DUE <br /> <br />QUANTITY ANOONT <br />I $~0.00 <br />13 $26.80 <br /> $3.80 <br /> <br />RECEIPT NO: <br /> <br />$79.80 <br /> $0.00 <br />$79.80 <br /> <br /> $0.00 <br /> <br />61177 <br />1560 <br /> <br /> RECEIVED BY: DM TYPE: OK CHECK <br /> * THIS IS A VALID PERMIT , THIS PERMIT EXPIRES 180 DAYS FROH ITS ISSUE DATE. IF <br />CONSTRUCTIOH CEASES FOR ~ RERIO~ OF lB) )AYe, OR IF COH~TRUCTIOM FAIL~ TO MEET ALL <br />REQUIREHEHTS OF STATE LA~S AND MARIOH CDUHTy ~UILDIH§ AHD ZONING ORDINANCES, THIS PERMIT <br />SHALL BECOHE HULL AND <br /> <br /> REMARKS: SERVICE CHGE &'13 CIE - FIRE REPAIR <br /> <br /> DONALD E,, WOODLEY~ MARIOH COUHTY BUILDING OFFICIAL BY <br /> <br /> OFFICE COPY <br />FORM # MC 15-$$ REV, <br /> <br /> <br />