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MARION COUNTY BUILDING INSPECTION <br />SEN%TOR 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 />lam pert~r..m, ing work on a properb I own or oocup, NT~7~. ~_.¢.~/~/~¢¢ <br />I af'~ a rog~¢tered builder OR the authorized representative $1GN~Tt~RB OF APPLiCA ~---~ <br />of a registered builder <br /> -</ <br />The work ¢~11 be performed by a registered budder <br />Other. <br /> <br />ow~IE',' ~0/10/80 ¥Ir4E: 14:o8:18 <br /> ROCKNEY, '-~,CR'TC;'.; G. <br /> <br />CONSTRUCTION TYPE OCCUPANCY <br /> <br /> ?498 ~ER~IAN RO <br />AUN~,$V 1LLB OR 97325 <br /> <br />CONTRACT CITY UGB <br />I~IAR I ON COUN FY NO <br /> <br />RESiDENtIAL. <br /> <br />MAILING ADDRESS ~ SUBDIVISION <br /> <br />4013 S.CALAK~GA Cf <br />W~[ LINN, OR 97008 <br />PHONE: 635~2630 ~llE NUr4BER: 11~27 <br /> VALUATION: <br /> <br /> 28 85 ]W EPU <br /> 13.64 AC NO NO <br /> <br />MAP <br /> <br />~YPE: EI,-ECI RiCAL <br /> <br />CONrRACfOR, NO- <br />LICgNS£ NO: <br />ROCKNEY, ~gRfON G. <br />4013 5.CALAROGA Cf <br />WESf LiNN, OR 97O68 <br />PHON~: 635-2630 <br /> <br />P~RNI'I OR APPLICAIlON NO: 902?992 <br /> <br /> SUPERVISING ELECfRiCiAN/NU~BB:R <br /> <br /> iFE~ <br />MANUPACfURED HOME S~RVICE/PEEOER <br />8RANCH CiRCUIfS - ON~ <br />F'LEEf SURCHARGE -ZONE 3 <br />ELECYRICAL S'IA'I'B SURCHARGE <br /> <br />~Y~; ROCKNgY, ~ARK <br />RgCblVgD BY: PR <br /> <br />QUANfIIY &~OUNI <br />2 $70.00 <br />~ $35.00 <br /> $3.84 <br /> $5.25 <br /> <br />TOTAL AcSSE'tS~ED FEES <br />FHtS RECEIP[ <br /> <br />$114,. gg <br /> $0. O0 <br />$114_0g <br /> <br />BALANC~ L%JE $0.00 <br /> <br />RECEiP~ NO: 29&94 <br />IYPE: CK CHECK ~: 1 <br /> <br />* THIS iS NOT A PERMi'f. THIS APPLICATION NUST GO THROUGH A REVIEW PROCEE~Z% WHERE THE <br />FOLLOWING MUSI BE COMPLETED. Il IS THE RESPONSIBILITY OF THE APPLICANI 'TO ASCSURE FHA¥ <br />ALL NEcEB~ARY iNFOI;;~ATiON HAIS BEEN PROVIDED. <br /> <br />PLAN REVIEW: BY <br /> <br />REtVlAR~: ~fl ~E:RV & CONN, <br /> <br />OAfE CiIY JURISDICrlON: BY OAIE <br /> <br />1- CIR R1$3338 <br /> <br /> OFFICE COPY <br />~ORM # MC 1 $-§6 R~V 4/tK~ <br /> <br /> <br />