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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;$0 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> The work will be performed by a registered builder, <br /> <br /> this document, <br /> J)ATE'.' 10/04/94 TINE:,' 12:05:24 <br /> <br />%E. AVY' ' FARH:' ~IT I~L <br /> <br /> l128e FAR~0 R~ -- <br /> <br /> PO ~OX 376 <br /> PNON[: 78e-2¢68 VALUATION= <br /> <br />NO be BEDROOMS <br /> <br />[ ] 4s law : <br /> <br /> TYPE= ELECTRICAL PERHIT OR APPLICATION NO= <br /> CONTRACTOR~ ilO. 73156 SUPERVISING ELECTRIC~AN/NUNBER <br /> ~ICENSE NOt <br /> teve L Horris <br /> PO Box 376 <br /> ~onald~ 97020-0000 <br /> FNONE: 981-0379 <br /> <br /> ITEM QUANTITY A~UUNT <br /> SE~¥~CE/FEE~ER LESS THAN 2~0 A~P$ Z $50.00 <br /> PUHP OR IRRI~ATION CIRCLE 1 ~40.00 <br /> ELECTRICAL STATE SURCHARGE $4.50 <br /> <br /> TBTALA$SE~SED FEES <br /> PREVIOUS RECEIPTS $0.00 <br /> <br /> $94.58 <br /> PAYEE: : <br /> RECEIPT NO: <br /> RECEIVED BY: QF TYPE: CNECK ~ 2952 <br /> * TH~S IS HOT ~ PERH~T~ TH~S ~PPLIC~T[OHHUST GO THROUGH ~ REV[E~ PROCESS ~HERE THE <br />FOLL~IH~ ~BST BE CO~PLETE~.::[TiS THE, RESPONSibiLiTY OF ~£ ~PPLICRHT TO ~SSURE THAT <br />~LL HESESS~RY [NFORH~TIOH HRS~EEN <br /> <br /> PLAN ~EVZEW= BY ............... DA~E2 .............. CITY JURISDICTION= BY <br /> <br />OFFICE COPY <br /> <br /> <br />