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NCOUNTY BUILDING <br /> INSPECTION <br /> SENATOR BLDG. NO. 225 <br /> 220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4;30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am performing work on a property I own or occUPY. <br /> <br />Other <br /> <br />have read and agree to the terms stated on the reverse side of <br /> <br />SIGNATURE OF APPLICANT: <br /> <br />°w~,~;f'E': 9?/05/90 <br />~ITU$ ADORES~;,~N HE~ <br /> <br />15:11:31 <br /> <br /> CON 8TRUC"~ION TYPE; <br /> <br /> 3ONTRAST CITY. UGS <br />SE <br /> <br /> MARION COLIN TY NO <br /> <br />6123 SHAW HWY <br /> <br />~R..,9.7525 <br /> <br />SUBDIVISION <br /> <br />CATEGORY: <br /> <br />OCCUrANCY: RES,[DEN f' [AL <br /> <br />OOQdPANT LOAD: <br /> <br /> NO OF BEUBOOM5 <br /> <br /> PHONE = '749~19'18 <br />LOf:BLOCK: <br /> <br />SECTION <br /> <br /> SI FE NUMBER: 18,584 <br />TOWNSHIP RA~;LUA] iON: ZONE <br /> <br />MAP: <br /> <br />48 <br /> <br />ELECTRICAL pEP, IVlI'f' OR APPL.,f, CAI'ION NO: <br /> <br />25~56 <br /> <br />CONTRACTOR, NO, 44,92? <br />~iOENSE NO: <br />(;~JAN'f Uf~ ELEC'[ RIC <br />'~4';~& 3~'f'H AVE NW <br />~SALE~4, OREGON 9?804 <br />PBONE: 362-4191 <br /> <br />SUPERVISING ELECTRiCIAN/NUMBER <br />DEAN GROZA <br /> <br />ONE NEN BRANCH CiRCUif';ALf'ER OR <br />FLEE]' SURCHARGE -ZONE 3 <br />F-LEClr R,[CAL S'f'AT F <br /> <br /> QUANTITY <br /> ] <br /> <br />TOI'AL ASSE.,SSrD FEES <br />PREVICXJS RECE [ P'f'~ <br />THiS Rr-;CE I PT <br /> <br />BALANC~ g~E <br /> <br /> AMOUNf <br /> $20,00 <br /> $s.84 <br /> <br /> $24.84 <br /> $0,o0 <br /> <br /> $o.oo <br /> <br />26856 <br />4403 <br /> <br /> PA,,Y, EE: QUANTUM ELEC'FRtC RECgIP'I' NO; <br /> REC~:~VED BY.' P8 ............................................................................................. TYPE: CK OHECK ~; <br /> THiS I.S A VALID PIE~IlT ~ THIS PEf~IT EXPtRE~ 180 DA~S FROM ][TS tSEitE DATE. <br />C~NSTRUCTION CF_,.ASE~ FOR A PERIOD OF 180 DAYS,. OR lie CONSTRUCTION FAILS TO iVlEET ALL <br />~Q~LIRf~IENTS OF STATE ~ AND ~IAR~ION COUNTY BUILDING AND ZONING ORDINANCES, THiS <br /> L BECOME NULL AND VOIDJ <br /> <br />REPG'ARKS: 1 CIR <br /> <br />f-)ONALD E. WOODLEY, IVLARiON COUN'T'Y BUiLDiNG OFFICIAL <br /> <br /> <br />