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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 22,5 <br />220 H&,'~H STF~EET 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 a registered builder OR the authorized representative <br />of a registered builder, <br /> <br />Other <br /> <br />COlV'C4E~ i Ag <br /> <br /> 99?8 S'f'AYTON ROAD SE <br /> AUI'4SV 1 LLE OR 97325 <br />USE OF' BUILDING; <br /> <br />f'4ARION COUNTY NO :,o o~ e~OR00MS <br /> <br /> ~ORK '769-5503 <br /> PHONE: ?69-?822 ~i'fE NUrC, SER: 92-01482 <br /> VALUA'f'iO~; <br /> <br />:W~DTH: iDEPT~: AREA: UNITS; 95 ~] EFU <br /> <br />TYPE= ELECTRICAL <br /> <br />CONTP, ACTOR. NO. <br />LICENSE NO: <br />CLIFF EiFFLER <br />1385 N FIRST SI' <br />~'IAY'f'ON. <br />PHONE: <br /> <br /> PER~Ii'I' OR APPLiCATiON NO: 9039358 <br /> <br />?7361 ~;~JPERViSiNG ~LEC'f'RiCJAN/NUC4'SER <br /> <br /> ITEM <br />PUMP OR ~RR~GA'f'&ON C~RCLE <br />ELECTRICAL S']'AfE ,5~URCHARGE <br /> <br />QUANTITY AJvlOUN'/' <br /> 1 $40.00 <br /> $2~oo <br /> <br />TOTAL A~$ES~ED FEES <br />PREVIOUS RECEIPTS <br />'f'H~S RECEIPT <br /> <br /> BALANCE OUE <br />PAYEEt ~iLCO FAR2,1ER ~ <br />RECEIVED BY: 0M2 ................................................... ~ ......................................... <br /> <br />$42, O0 <br /> $o_oo <br />$3?.80 <br /> <br />$4.20 <br /> <br />RECEIPT NO= 41402 <br />TYPE; OK CHECK ~; 18134 <br /> <br />*THI$ 15 NOT A PER~iT. THi~ APPLICATION fflUSTGO THROUE~-t A REViE~H PROCE.,.,m~ INHERE THE <br />FOLLOWING I~LIST BE COMPLETED. IT [$ THE RESPONSIBiLiTY OF THE APPLICANT TO ~RE THAT <br />ALL NECES~,_~C. RY INFOf~IATION HA~ BEEN PROVIDED. <br /> <br />PLAN REViEN: BY OATE <br />REMARKS: NEN F%JN~ iNSTALLAT:IONONLY <br /> <br />CiTY JURISO1C'I'ION: BY OATE <br /> <br />OFFICE COPY <br /> <br /> <br />