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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 /> <br />I ara perf°rmd~g w°rk °n a pr°perry I °wn °r °ccupy' {~'/-~' "~' J~ /~'"1 ~ <br />I am a registered builder OR the authorized representative SIGNATURE OF AC'PUOANT: . ~ t <br /> of a registered builder. <br /> ! <br />Other.Thew°rkwilJbeperf°rmedbysreg"tered b,ilder. ~ /~_~./~ <br />I have read and agree to the ~erms stated on the reverse side of DATE; <br />this document. <br /> <br />owN~i~AT E: 04/28,/92 f',[C4E: 8:24.14. <br /> <br />TAX LOT; ; CATEGORY: <br /> <br />CONSTRUCTIO~ TY~E: 74780-100 · OCCUPARCY; <br /> <br />RESiDEN'¥'IA <br /> <br /> bO~¥~SfCJfv:~ !UGB: 10CCUPANTLOAD: <br />207010UVEFFEA, D RD NE <br />AURORA OR...~OO2 : : ; <br />USE OFBUILDING: ~.RJON COUNTY NO ,N00FB£0R00MS <br /> <br /> SANE <br /> INK ~r 538-3141 <br /> PHONE.* 678-1082 SITE NUIV~ER: 92-01442 <br /> LOT: i BLocKi !'~GflO~J TOWNSHIP: ~A~d~AI~UA'f ~'bhbl <br /> <br />WIDTH: :DEC'TH~ AREAz 3'8' :U~1¥$: 4-,S I~G. LO'C: '~lAI ;OO~NER: EFU <br /> <br /> 5. _: AC ' NC,: NO <br /> <br />MAC': <br /> <br />4 <br /> <br />TYPE: ELECTRZCAL <br /> <br />CONTRACTOR,. NO, <br />LicENSE NO; <br />BRANNON, ~ <br /> <br />iNK ~ 538-3141 <br />PHONE: 578--1082 <br /> <br />PER~IT OR APPLiCATiON NO: 9039632 <br /> <br /> .~JPERViSiNG ELECTRICiAN/NUmBER <br /> <br /> I'rEJ"l <br />8RANCH CIRCUIT, WITHOUT 8ERVICE OR FEEDER - 1ST CIRCUIT <br />BRANCH C[RCU[T, ~ITHOUT SERVICE OR FEEDER - EACH ADD1I'1ONAL <br />ELE~C'FRICAL STATE SUR(~IARGE <br /> <br />PAYEE=BRANNON; RON <br />RECEIVED BY: CL <br /> <br />QUANTJ')'Y AI~OUN'I' <br />1 $35.00 <br />I $2.00 <br /> $~.85 <br /> <br /> TOTAL A;%~E~ED P'EE~ $38.85 <br />¢~:. PI:~."'V'tC~S RECEIP'F~ $0.00 <br /> THiS RECEIPT $38.85 <br /> <br />BALANCE DUE $0.0o <br /> <br />RECEZPT NO: 41676 <br />TYPE; OK CHECK ~: 719 <br /> <br />~ THIS 15 NOT A ~IT. THIS APPLICATION ~U~T ~0 THROUGH A RE¥1EN PROCE:~S i,~ERE THE <br />I~LO~iN~ IVlJST ~C(~LETED. iT I~THE RF~;PONSIBILITY OF THE APPLICANT TO A._~RE THAT <br />ALL NECI~ARY [N~TION HA~ BEEN PROVIDED. · <br /> <br />PLAN RE¥1E~: BY ....................... DA'rE <br />REHARK3: 2 CIR ADD 1:~1:39305 <br /> <br />Cll'Y' JURISDiCTioN: BY <br /> <br />DA'f'E <br /> <br />FORM # MC 15-56 REV. <br /> <br />OFFICE COPY <br /> <br /> <br />