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MARION COUNTY BUILDING INSPECTION <br />SENATORBLDG NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> I pHONE: 588-5147 · 8:00; 4:30 <br /> =; '24 HOUR CODE-A-~PHONE!588-7904 <br />I am perform¢~9 work on e property I oWr~ or occupy <br />I am a registered builder OR he au hot zed rep esen a ~e SIGNATURE OF APPLICANT <br /> of a regis.feted builder. - <br />The work will be per[ormed by a r6~ s ere~ bu der <br />Other ....... <br />I haYe read and agree to the terms stated on the reverse side of <br />this document <br /> <br />s~-~%~t.T E~-]397'20,/91 .... T .tNE ~'---a ~-£5'8-?1'8 .................. f~.~ £~¥ ........................ ~ ........ 8~TS'8~'F ................ ~, <br /> u~-X~b~¢AT~.- ~- .......................................................... 5~2Z~=0Q0 ............................... R~&D~ TZ~[ <br /> CONSTRUCTION TYPE OCCUPANCY <br /> <br /> 9624 NILL CREEK RD SE CONTRACT C~Y, ~ UGB OCCOPANT' *LOAD <br />~VJLLE OR 97325' yZLL~: -:'-"-:--'-'"'RO[ .................... ~'~'6'-~'~Ed,6o~ '''-j <br />~'iC~%%~;S ................................................. ~5~;~iS~fi ............................. <br /> <br />PHONE: 749-2846 <br /> IBLOCK <br /> <br /> SI 1E NUIVlBER: 14110 <br /> ............ VAL.LIAT_ZDN .-, ...... <br /> ? ~- ~'¥i~) N !TOWNBH~P RANGE ZONE <br />....... ~ 0. t ~ RO NO <br /> <br />TYPE: ELEC f RiCAL <br /> <br />OC.~ 1RACl OR, NO. <br />LICENSE NO: <br />BATES, e_~a. Ry <br />SAt,IE <br /> <br />PHONE: 749-284-8 <br /> <br />PEF~I f' OR APPLiCATiON NO: 35142 <br /> <br /> SCJPERVIS l NG ELECI'R I C I AN/NUtted ER <br /> <br /> iTEI~ <br />BRANCH CIRCUITS - TI~D TO 'FEN <br />ELEC1RICAL $1AlE SURCHARGE <br /> <br />· ' TOTAL/ASSESSED FEES <br /> 'PREVIOUS RECEIPTS <br /> ' TPII3 RECEIPt, <br /> <br /> BALANCE ICXJE <br /> <br />AJ'4C~ N Il <br /> $50.00 <br /> $~.5o <br /> <br />252.50 <br /> 52.50 <br /> $o.oo <br /> <br /> RECEfVED BY. PfC ...... ,,-_-,;,~:~'.,..='_~..:2,2:_~_~ .......... ,TYPE: CHECK ,I;: 0 <br /> <br />C(:]N~TRUCTION ~ FOR A ~IOD:OE'~,180 OAY~,,';;O~ I,F/CX;i~iTRUCT.f. ON FAIL3 TO IvI~EET ALL <br /> <br /> R~RKS: CIRCUIIS <br /> <br /> BUI'LDIN~'Off~OiAL ~/ BY , ...... ~___ ................... <br /> DC~ALD <br /> ~)ODL~Y, <br /> ~ARi~N <br /> <br /> <br />