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RP,.S! L)k.N l J. AL <br /> <br /> DE]ORr T OR 9.'~"342' CONTRACT CITY <br /> ~RI~ COUNTY ffNO <br /> BUILDING <br /> <br /> P.O_ 681 OEF~if, OR 97342 <br /> PHON~ 854~38U/ 1226~ <br /> <br />WIDTII DEPTH AREA LiNITS IRREG LOT NO CORNE~o <br /> <br /> MARION COUNTY BUILDING 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 /> , I am perforrT~m9 work on a property I o¢~n or occupy ~ <br />~/ [ ~m a.ro..gJsterod budder OR f I tho autho¢~zed represen a ire s GN~TUR~ OF APPLIO,~NT ~ <br />o a registered builder, <br />i/ Thework~.illbeperf~rmedbyar'og,$teredbuilde, <br />, Other~ <br /> <br />OWNER $1AI e,,. OF ORE HNY OEP'l. r^x LOT <br /> <br />TYPE: ELP,.C f RiC.aL <br /> <br />CON 1 RAGI OR. NO_ <br />L I CP_C4~E- NO: <br />'>IA~E OF Ot'~ HWY DEPT_ <br />REN¥OR~ ["4CNERNEY. J[':RRY <br />F>.O. 681 DETRO.(f. OR 9?342 <br />PkflONE: 854'-380 ? " <br /> <br />T'AAN~FAC TUREO HOI'4.P. ~ERVICE/P'EEESER <br />Et-Er,;TRICAt. 51ALE SURCHARGE ' <br /> <br /> $35_00 Z <br /> <br /> FO'f'AL A,~.~E~EO FEES 7_0o <br /> PREVIOUS RECblP'~S $0_ 00 <br />/ THIS RECE.f, P f <br /> BALANCE DUE $0.00 <br /> <br /> P4.Y.E'e': MCNF-RNEy Lk.C~4Ng RECFIP Nn <br /> - / YPE: CK CHECK <br /> <br /> uW,~aG I~a/ ~ ~HLb/EU+ IT iS THE RES~SIBiLiTY OF THE APPLICANI <br /> ALL NEC~ARY~[I~ H~ BE~ P~iDED. .., <br /> <br />FORM ~ MC 15-56 REV 4Z90 OFFICE COPY <br /> <br /> <br />