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MARION COUNTY~UILDING INSPECTION <br />SENATOR BLDG NO 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4::30 P,,M - 8::00 A,M <br /> <br />of a registered builder, <br />Tho ¢,ork ¢,ili be performed by a registered builder <br /> <br />PATE: 05/28/8? TINE: 12:45:51p <br />OWNER <br /> Iv[A f R, JANES <br />$~TUS ~CBRE$8 <br /> <br />SIGNATURE OF APPLICANT <br /> DATE <br /> <br /> TAX LOT <br /> <br /> CONSTRUCTION TYPE <br /> <br />CATEGORY <br /> <br />OCCUPANCY <br /> <br /> 7727 ,,~4EI;~!AN RD SE CONTRACT CITY UGB OCCUPANT LOAD <br />AUNSVI LLE OR 97325 <br /> <br />USE OF BUILDING <br /> <br />MAILING ADDRESS SUBDIVISION <br /> <br /> SANE <br /> <br /> PHONE: 749-1339 SITE NUNBER: 1501 <br /> VALUATION: <br /> <br />LO~ BLOCK SECTION TOWNSHIP RANGE ZONE MAP <br /> 28 8S 1N AR <br /> 1.55000 AC N N <br /> <br />48 <br /> <br />TYPE: ELECTRICAL PERNIT OR APPLICATION NO: 9002381 <br /> <br />CONTRACTOR, NO. <br />LICENSE NO.* <br />MIR, JANES <br />SANE <br /> <br />SUPERVISING ELECTRICIAN/NUIVfEER <br /> <br />PHONE: 749-1339 <br /> <br /> ITFJ4 <br />SERV CHANGE ONLY-EXISTING RESIDENCE <br />TNO OR NORE NB CIRCUITS;ALT OR EXT <br />FLEET SURCHARGE -ZONE 3 <br />ELECTRICAL STATE ,?~JRCHARGE <br /> <br />QUANTITY AJ~OUNT <br />1 $20.00 <br />1 $20.00 <br /> $3.84 <br /> $1.60 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$45.44 <br /> <br />$45.4.4 <br /> <br />BALANCE DUE $0-00 <br /> <br />PAYEE: NAIR: JANES RECEIPT NO.* 2875 <br />RECEIVED BY. cl ..... · _~ i TYPE: CK CHECK ~: 200 <br /> <br />· THIS IS NOT A ~IT. THIS APPLICATION:.:.I~.T 60 THRouGH A REVIE~ PROCEE~ I~HERE THE <br />FOLLOWING MUST BE COMPLETED IT ~8;THE R~IBILiTY OF THE APPLICANT TO ASSURE THAT <br />ALL NECES~ INFORMATION HAS BEENPROVIDED. <br /> <br />PLAN REVIEN: BY ....... DATE .......... <br />REFL&RK~: SC-2¢IR <br /> <br />CITY JURISDICTION: BY ......... DATE .......... <br /> <br />OFFICE COPY <br /> <br /> <br />