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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH ~T~EE~ N~= <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:80 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am performmg work on a property I own or occupy. <br />I am a registered builder OR ) the auti3orl;~ed representative <br />of a registered builder. <br />The work will be performed by a registered builder, <br />Other <br /> <br />ow~C~:'r6 ~ 02/13/91 T I¢4E: 16 ~'23 .- t5 <br /> <br />'TAX LO"F: <br /> <br />I OCCUPANcy; R~IDENT IAL <br /> <br /> CONTRACT CITY: i U~B: ]OCCUPAN'f LOAB: <br />9332 SAN'riA~ LOOP SE <br />AUIvlSV I LLE OR 9?325 ~ ' <br />us~ OF aU~Le*.~: ....................... '~i'~ ~NTY ...... ~0 ...... ' '.,0 o¢ <br /> <br />MAILING ADDRESS: <br /> <br />suemws~sN: <br /> <br />LOT: BLOCK; <br /> <br /> SiTE NUIVlBER ~ 2~.32 <br /> <br />AREA'· i UNITS: REG. L0f'. ' O0RNER: <br /> <br /> ...... NO ; NO <br /> <br />TYPE: ELECTRICAL PER,lIT OR APPLICATION NO++ 9030396 <br /> <br />f2ONTRACTOR, NO. 45933 <br />LICENSE NO: <br />PACIFIC COAST ELEC.,INC. <br />P.O. BOX 651 <br />STAYTr-..~. OR 97383 <br />PHONE: 769~7671 <br /> <br />,~UPERVlSING ELECI'RICIAN/NUIV~ER <br />LEONARD I~IYERS <br /> <br /> ITE~I <br />SERV1CE/EEEOER 101 TO 400 AJ~F~ <br />ELECTRICAL STATE SURCHARGE <br /> <br />r,,~JANTiTY AMOUNT <br /> 1 $60.00 <br /> $3.o0 <br /> <br />TOTAL A,%~ED FEE~ <br />PREWIOUS RECEIPTS <br />THIS RECEIP'r <br /> <br />$63.00 <br /> $o,oo <br /> <br />* THIS iS NOT A ~[T. THI~ APPLICATiONFILiST'(~oTHROU(~"I A REVIE~I PROCE~.~ 1AHERE THE <br />I~OI..LO~IN~iV~JST BE CO~IPt. ETEO. IT IS THERE~PON~iBiLITYOF THE APPLICANT TO--RE THAT <br />ALL NECESSARY INFOI;i~ATION HAS::BEENPROViDED. <br /> <br />PLA~ REVIEW: BY .......................... DATE <br />REJVlARKS: 200 AI~P ~ERV CH/~qGE R~5902 <br /> <br />CITY JURIE~)ICTION: BY DATE <br /> <br />~OR~ # ~C ~S.S~ R~V..~ OF FICE COPY <br /> <br /> <br />