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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, 225 <br />220 ~41G~-~EET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 P.M. - 8:00 A.M, <br /> <br />I arr~ performing work on aproperty I Own Or occupy. <br />I am a registered builder OR the authorized representative <br />of ~ registered buildor. <br />The work will be performed by a registered builder. <br />O frier <br /> <br />have read and agree to the terms stated on the reverse side of <br />th~s document. <br /> <br />g~$: o2/23/9o <br /> PACK,BRUCE <br />SITt. JS ADDRESS: <br /> <br />TIME: 11=05:20 <br /> <br />'fAX LOT: <br /> <br />CONSTRUCTION TYPE: <br /> <br />CATEGORY: <br /> <br />OCCUPANCY: <br /> <br />COf~ERCIAL <br /> <br /> 12264 SILVER FALLS <br />AUMSVILLE OR <br /> <br />USE OF BUILDING: <br /> <br />9?225 <br /> <br /> CONTRACT CITY: UGB: <br /> <br />FUkRION COUNTY NO <br /> <br />gUBDrVISION: <br /> <br />SAME <br /> <br />PHONE: 769-2139 <br /> <br />I,OT: BLOCK: <br /> <br />SECTION: TOWNSHIP: <br /> <br />SITE NUMBER.* 9504 <br />VALUAT I ON: <br /> <br />MAP: <br /> <br />WIOTH: DEPTH: AREA: <br /> <br />0. NO NO <br /> <br />TYPE: ELECTRICAL PERMIT OR APPLICATION NO.' <br /> <br />22077 <br /> <br />CONTRACTOR, NO- 10875 <br />LICENSE NO-' <br />CHERRY CITY ELEC <br />PO BOX 12666 <br />SALEM ORE 97209-0668 <br />PHONE: 399-7609 <br /> <br />SUPERVISING ELECTRICIAN/NUMBER <br />JON J ~OLF <br /> <br /> I TEN <br />C/I SERV 201-400 AMP~ <br />FLEET E~JRCHARGE -ZONE 4 <br />ELECTRICAL STATE SURCHARGE <br /> <br />(TdANTITY ~viJlJNT <br /> I $100.00 <br /> $5.12 <br /> $5.oo <br /> <br />TOTAL,'ASSESSED FEES <br />PREV[OUSRECEIPTS <br />THIS RECEIPT <br /> <br />$110.12 <br /> $o,oo <br />$110.12 <br /> <br />SAI.¢~CE DUE $0.00 <br /> <br /> PAYEE.' CHERRY CITY ELEC RECEIPT NO: 22402 <br /> RECEIVED BY; PR TYPE,. CK CHECK ~: 15790 <br />~ THIS IS A VALID PEI~IIT ~ THIS:';PERMIT, EXPIRE~ 380,' ~'~ ITS I~E ~TE. IF <br />~5T~I~ ~ ~E A PERI~D'.O~'?180 ~,. OR .~F'~I~ FAI~ TO M~ ALL <br />~I~T~ OF STATE ~ ~RI~ ~ 8uI~I~ ~D ~ING ORDIN~C~. ~IS PE~IT <br />~ALL 8~E NU~ ~D ~ID.. '. .' ..' ': <br /> <br /> R~RKS: SERV <400 ~P R~6450 ~~ <br /> ~ALD E. ~BLEY, ~R~ ~N~ BUZLD[NG OFFICIAL / BY . ............................................. <br /> <br /> <br />