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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 />The work will be performed by a registered bvilder, <br />Other. <br /> <br />I have read ~nd agree to the terms stated on the reverse side of <br /> <br /> this document <br /> <br /> ()Al'E:: i2/29/92 'riME: 11-"04:56 <br />OWNER; <br /> DUNCAN ,,1AMY'S E & DOROTIqY Y <br /> <br />SITUS ADDRESS; <br /> <br />TAX LOT; CATEGORY: <br />61385'-000 , RES IBENI':[A[.. <br />¢~NS~RUOTION TYP~; OCCUPANCY: <br /> <br /> 9053 W STAYTON RD <br />AUMSVILLE <br /> <br /> SE : 60'NTRACT ~ ~l Limb: <br />OR 97525 ,MARION CODMfY: HO <br /> <br />OCCUPANT LOADz <br /> <br /> NO OF BEDROOMS· <br /> <br />, AME <br /> <br />PHONE-" 749-J, 545 <br /> <br />SITE NUMBER: 92-04:565 <br />VALUA'F I ON: <br /> <br />BLOCK: SEcTiON: ; fbwi~§;iFi RABGE: ZONE: MAP: <br /> <br /> 1 9$ 2W EFU 62 <br />DEPTR; ' AREA: UNITS; IRRE¢~. LOT: CORNER: <br /> 4.98 AC "" ' NO <br /> Y ::. o <br /> <br />TYPE: ELECTRICAL PERMIT OR APPLICATION NO: 9044640 <br /> <br />CONfRACTOR, NO. <br />LICENSE NO:: <br />DUNCAN, JAMES E & DOROTHY Y <br />SAHE <br /> <br />SUPERVISING ELEC'FR I C I AN/NUMBEF,. <br /> <br />PHONE: '?-19,,,2,545 <br /> <br /> ITEH <br />MANUFACTURED NOME SE~VICE/F'EEDER <br />ELECTRICAL STATE SURCHARGE <br /> <br />QUANTITY AMOUN F <br /> 1 $ 40. 00 <br /> $2, O0 <br /> <br />TOTAL ASSESSED FEES <br />PREV[OUS RECEIPTS <br />THIS RECEIPT <br /> <br />$4'f .00 <br /> $ 0.00 <br />$4 ?_' _00 <br /> <br /> 8At, ANON DUE $0.oQ <br />PAY~:: OUNCAi% ~AM[,,';'.S ~ & DOROTHY Y RE,El, FI NO: 46788 <br />RECmIVEO BY: DH2 .............................................~ ........................... TYPE: CK CMECK ~: 2247 <br /> <br />~ THIS IS NOT A PERMIT. THIS APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST BE COMPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFORMATION HAS BEEN PROVIDED. <br /> <br />PLAN REVIEW: BY ........................ DATE ....................... <br /> <br />REMARKS: REPLACE EXISTING SERVICE <br /> <br />CiTY JURISDICTION:: 8Y .................... DA'rE ..................... <br /> <br />~O~M ,~ ~c ~-~s ~EV. ~o OFFICE COPY <br /> <br /> <br />