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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 /> <br />I am a registered builder OR ( ) the authorized representative <br /> <br />it hh{~V~orceu~md ~nnt~ agree to the terms stated on th~_r~e.~ide--of <br /> <br />(: ARENBT, LARRY ~ 41846-888 RESIDENTIAL <br />ISITUS ADDRESS~ ~ CONSTRUCTION TYPE: OCCUPANCY~ <br /> <br /> ........... i"O~i i06CUPANT LOAO: <br /> 28757 CASE RD NE !CONTRACT CITY: <br />AURORA OR 97882 ~ARION COUNTY IYES I <br /> <br />SAME ' <br /> ! SiTE NUHB£R: <br />PHONE: 678-§8?0 I VALUATION: <br /> <br />i WlDTH: DEI;THJ I ~A: I UN~: ~EG. LOT: <br /> L 35. AC : NO <br /> <br />TYPE: ELECTRICAL <br /> <br />CO~TRACTOR~ NO. <br />LICENSE NO: <br />ARENDT~ LARRY <br />SA~E <br /> <br />PHONE: ~78-5890 <br /> <br /> ITEM <br />MANUFACTUREQ SOME SERVICE/FEE~£R <br />ELECTRICAL STATE SURCHARGE <br /> <br />PERHIT OR APPLICAT~OH NO: 9ess771 <br /> <br /> SUPERVISING ELECTRICIAN/HUMBER <br /> <br />OUANTITY AMOUNT <br /> I $40.00 <br /> $2.88 <br /> <br />TOTAL ASSESSED FEES $42.80 <br />PREVIOUSREOEIPTS $0.08 <br />THIS RECEIPT $42.00 <br /> <br />:.BALANCE BUR $8~ 00 <br /> 6t$41 <br /> <br /> PAYEE: ARENDT: LARRY :: '-:ii::. : .. RECEIPT NO: <br /> RECEIVE~ BY: Mb ..... ~_.~£L .......... ~ ............ TYPE: gK CHECK ~: <br /> <br /> $ THIS IS HOT A PERHIT. THIS APPL[CATiONNflSTF_.OTHRGUCN A REVIEM PROCESS WHERE THE <br />FOLLOWING HUST BE COHPLE[ED,:;:[:T.ISTHERESPONSI~ILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY IHFORHATION HAS~EEH PROVIgED. <br /> <br /> PLAN REVIEW: BY .......... :DATE:~ ............. CITY JURISDICTION: BY ........ DATE <br /> ~EMARK$: MS SER¥ CH~ <br /> <br />O:FICE COPY <br /> <br /> <br />