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MARION COUNTY BUILDING INSPECTION <br />SENATOR E~L,DG. NO. 225 <br />22.0 HIGH' ~TREET 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 pertorming work oR a property I own or occupy. <br />lamareglsteredbuirderOR( Itheauthorizedreppesen~atWe <br />of a registered builder, <br />The work will be performed by a registered builder. <br />Other <br /> <br />SIGNATURE OF AI2PLICANT: <br /> DATE: <br /> <br /> DATE: 06/20/90 'ri~'lE: 14:19:29 <br />OWNER: <br /> HAWORTH, <br /> <br /> TAX LOT: <br /> <br /> CONSTRUCTION TYPB: <br /> <br />NE OONTFt~CT CITY: UGB: <br /> ~RiDN COUNTY NO <br /> <br /> 11920 FARGO RD <br />AURORA <br /> <br />OR 9'f092 <br /> <br />SUBDIVISION: <br /> <br /> PI40~E: 678-5019 <br />LOT:BLOCK: <br /> <br />RES1 DEN'I' IAL <br /> <br />WIDTH: DEPTH: AREA; <br /> <br />SITE NUMBER: 104.34 <br />VALUAT iON: <br /> <br /> NO NO <br /> <br />'f'¥PE; ELECTRICAL <br /> <br />CONTRACTOR, NO. 4.2047 <br />LICENSE NO: <br />TODD K~NAG¥ ELECTRIC <br />111NW 2ND STREET <br />CANBY, OREGON 9'7012 <br />PHONE: 263~8828 <br /> <br />PERMIT OR APPLICATION NO: 9025025 <br /> <br /> SUPERVISING ELECTRICIAN/NUMBER <br /> <br /> if'F_J'4 <br />C/i SERV 201-400 AIvlPS <br />C/i FEEDER 101-200 AMP8 <br />THO OR IvlORg NEW Cl~i'rS~AL'r OR ~'r <br />FLEEr' ~HA~E -Z~E 6 <br />EL~'fRlCAL STATE ~A~E <br /> <br />OUANTII'Y AMOUNT <br />I $100,00 <br />2 $80.00 <br />2 $60.0O <br /> <br /> $12.00 <br /> <br />TOTAL ASSE'~-~SEO FEES <br />PR~W]OU~ RECEIPTS <br />THiS RECEIPT <br /> <br />$259_68 <br /> $0.00 <br />$112_68 <br /> <br /> PAYEE 'f'OOfJ KE_NAGY ~L£C'rRzc "~%. REC£iPT NO: 26497 <br /> R~EtVED BY: ~ .......~.~ 'rYPE: OK ~ECK ~: 0 <br /> <br />~L~IN~ST'~'~~. iT IS:THE R~IBILITY OF THE ~PLI~T TO ~R~ THAT <br /> <br />PLAN RE¥1EW: ~Y .................................... DATE ................................... CiTY JURi3DiC'flON: BY .............................. DATE <br /> <br />RE~IAR~: 400 A~,IP R~3512-$112.58 (BALANCE DUE) <br /> <br /> O)= FICE COPY <br />FORM ¢/MC 15-56 REV. 4/90 <br /> <br /> <br />