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~TE~T~ <br />TYPE <br />~CUP/~C.Y <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br /> <br />WORK O~C <br /> <br />SITE ADDRFSS <br /> <br />: SERV/RELOCATE <br /> <br /> 6164 SHAW LN SE AM <br /> <br />CITY: MARION COUNTY <br /> <br />CROSS STREET : SHAW SQUARE RD <br /> <br />PARCEL HIIMBER : 75~-I30 <br /> <br />OWNER NAME : KLUG, DFAN H & KAREN J <br /> <br />APPI.ICANT <br /> HAME <br /> ADDREfiS <br /> <br />PHONE : <br /> <br />: K[rUG,DEAN H & KAREN J <br />: <br /> 6t64 SHAW l.H SE <br /> AIIMSVI[.LF, OR <br /> <br />97~25 <br /> <br />CONTRACTOR : KLUG,DEAN H & KAREN J <br /> PHONE : <br /> <br />ELECTRICIAN : <br /> PHONE : <br /> <br />SIIPV EI.EC : <br />PHONE : <br /> <br /> OCCB: <br />CONTRACTOR LICENSE: <br />SUPERVISOR LICENSE: <br /> <br />Units Description Fee <br /> I ...... ~'eFV'~"~?¥eeders up to 2BB amps ~B, OB <br /> t State su?char§e 2.5B <br /> 1 Refund .OB <br /> <br /> Assessed fees : 52.50 <br /> Adjustments : <br /> Total fees : 52.5B <br />PAYEE: K[[I~,DFAN H & KAREN J Total paxments: 52.50 <br /> ~alance due : <br /> <br />THIS PF/~IT IS HOM-~ERiIi~LE MD EXPIRES 18~ H¥S FR~ ISSUE DATE IF kKIRK <br />HitI1T~B,OR IF COHSCOHSTRUCTIGH CEASES FOR ~ ~][OD OF 1811 DAYS. OR IF WORK <br />FAILS TI] NEET ~LL REGUIREIIEHTS OF STATE L~ &fiD. ~I-(]g ~ ORDIH/tHCES. UPOH <br />WRITT~# REI~IFSTs OI4F SIX flOHTH EXTEHSIOH I~Y BE ~' <br /> <br />~IGNATIIRE OF APPLICANT: <br /> <br />DONDAI.D E WOODLEY, MARION COIINTY ~IJII.DINBG OFFICIAL / BY HBULL <br /> <br /> <br />