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MARION COUNTY BUILDING INSPECTION <br />SENATOR~C~-,gOG. NO. 225 <br />22~- HIG~;CSTREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4;30 RM, - 8;00 A,M. <br /> <br />I am performing work on a property I OWr~ or occupy, <br />I am a registered Duilder OR the authorized representative <br />of a registered builder. <br />The work will 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 dooument. <br /> <br />SIGNATURE OF APPLICANT: <br /> <br /> DATE: <br /> <br />OwN~AIf'~: 05/04/90 TIME: 1t:38:11 <br /> FERY, DENNIS <br /> <br />TAX LOT: <br /> <br />GONBTRUOTION TYPE: <br /> <br /> lO748 5'faY'toN rD <br /> AU~ISV! LLE <br />UgB OF BUILDING: <br /> <br />OR 97325 <br /> <br />~ONTRACT CITY; <br /> <br />letARi ON ~NTY <br /> <br />UGB: <br /> <br />CATEGORY: <br /> RE5i DENT' iAL <br />OCCUPANCY: <br /> <br />NO <br /> <br />OCCUPANT LOAD: <br /> <br /> NO OF BEDROOMS: <br /> <br /> PHONE: 769-6983 <br /> <br />LOT: BLOCK: <br /> <br />WIDTH: DEPTH: <br /> <br /> SiI'E NUIW~ER; 10085 <br /> VALUAI' ! ON: <br />RANGE: ZONE: <br /> <br />NO NO <br /> <br />MAP: <br /> <br />TYPE: ELECTRICAL PEf.~3'.I!T OR APPL!OATION NO: <br /> <br />2,3'187 <br /> <br />CONTRACTOR, NO. 45933 <br />L .I, CF.3'4~ E NO: <br />PACIFIC COAST gLEE;. ,!NC. <br />P+O. BOX 851 <br />STAYTON, OR 9?383. <br />PHONE: 769-7671 <br /> <br />SUPERV J.S].NG ELECI'RI C iAN/NUfCiB ER <br />LEONARD f,4YER$ <br /> <br /> l'l'E~ <br />SERV CHANGE ONLY-EXISTING <br />FLEE]' SURCHARGE -ZONE 3 <br />ELECTRICAL STATE ::AJRCHAR~E <br /> <br />OUANTII'Y AhXAJNT <br /> 1 $3o.oo <br /> $3.84 <br /> $1.5o <br /> <br />TOTAL,A,%~ED FEE'S <br />PR~WiCtJ$',RECEIPT~ <br />1'HIS RECeiPT <br /> <br /> $o.oo <br />$35.34 <br /> <br />BALANCE DUE $0.00 <br /> <br /> PAYEE: PACiF!C (.7,3A~'r ELE¢.~:~N6; RECEIPT NO- 25201 <br /> RECEIVED BY: PR ............ ~_2~2'~ ...... TYPE: ,,CK CHECK ~; 4242 <br />~ THIS I~ A VALID PIS~I~.'* ~H/L:5't~ZT E~PiRE~ 18~ OAY~,PRIIR ITS I~E DATE. IF <br />~T~CTI~ C~ ~ 180 ~; ~ IF',~TI~ FAl~ TO ~T ALL <br />~I~ OF STAT~ ~ . I:~NTY BUI~iNG.~O Z~ZNG OR~iN~C~. THIS P~IT <br />~ALL B~ ~LL ~D~ZD. ' <br /> <br /> RE~RKS: SE~ ~6 FOR ~zs'r' R~ ~6742 <br /> ~NALD E. ~DLBY, ~RJ~'C~NTY BUJLDZN60FEJC~AL / B <br /> <br />FORU ¢ MC 15-58 RE~ 11/8~ OFFICE COPY <br /> <br /> <br />