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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG, NO. 225 <br /> 220 HIGH STREET NE <br /> ~ SAEEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 P,M. - 8:00 A,M. <br /> <br />I am performing work on a property I own or occupy. <br />lart~AregisteredbuilderOR( )theautt~orizedrepresentative <br />of a registered builder, <br />the work wil~ be performed by a registered builder. <br />Other <br />I have read and agree to the terms stated on the reverse side of <br />this document. <br /> <br />:'¢9~' 09/01/es T;ME: <br /> <br />SITUS ADDRESS: <br /> <br /> 900 N 8TH ST <br /> AUMSVILLE <br />USE OF BU~L6~NGi <br /> <br /> 4 .'34 .* 22p ;TAX ............... LOT'. i ~AiEGOHY: <br /> <br /> RESIDENTIAL <br /> <br />OR 9?325 ; <br /> A~V~EUE ...................... N9 - ' <br /> <br />DEL.~__ZJ:_Z_ <br /> <br /> PHONE:. <br /> <br />:LOT: <br /> <br /> SITE NUMBER: 53?9 <br /> <br /> i A ~ E A: ; g N ITS; ]'~'~ <br /> SF <br />95 <br /> <br />TYPE: ELECTRICAL PERMIT OR APPLICATION NO: 9010886 <br /> <br />CONTRACTOR, NO. <br />LICENSE NO: <br />TON OCR/44 <br />PO BOX 185 <br />SUBLIMITY 97385 <br />PHONE: 769-7354 <br /> <br />55493 <br /> <br />SUPERVISING ELECTRICIAN/NUMBER <br /> <br /> iTEM <br />TEMP CONSTR SERVICE <br />FLEET SURCHARGE ~ZONE 3 <br />ELECTRICAL STATE SURCHARGE <br /> <br />QUANTITY AMOUNT <br /> $20.00 <br /> 3.84 <br /> <br /> TOTAL ./]C.-.-.-.-.-.-.-.-~SE,SSED'FEES $24.84 <br /> >REVIOUS RECEIPTS $0.00 <br /> THIS RECEIP~ $24.84 <br /> (~BALANCE DUE $0.00 <br />PAYEE: TON DC)RAN RECEIPT NO: 11598 <br />RECEIVED BY: dm ..... TYPE: ~N CHECK ~: 0 <br />* THIS IS NOT A PERMIT. THIS APPLICATION NUST,'GO,,THROUGH A REVIE~ PROCEExS iNHERE THE <br />FOLL.C~ING MUST BE COMPLETED. IT IS THE RESPONSIBILITY~'OF THE APPLICANT TO AS..WdRE THAT <br />ALL NECEE,..SARY INFOI:~{ATION HAS BE[!~4 PROVIDED; <br /> <br />PLAN REVIEW: BY DATE <br /> <br />REMARKS: TE <br /> <br />CIff~' JURISDIOT,ION: BY DATE <br /> <br />,e,M ~, MC ~.~ "~V e/e~ OFFICE COPY <br /> <br /> <br />