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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 am ~x registered builder OR ( ) the authorized representative <br />ota registered builder, <br /> <br />Other <br /> <br />I have read And agree o the terms stated on the r~versa side <br />this document, <br /> <br /> l" .' 2'f2 ............. ,, .................... OCCUPANCY: Z[At <br />, ~)ETFd]]'.T ~ k 97~42 DETROIT NO ( ~'~h5~s: <br /> <br /> .Ci. ES2 gR <br /> PO BOX 572 <br /> <br /> PHOI,IE: 854-.-',~7~62 VALUA-f I[]N: <br /> <br />WIDTH'. ;,DEPTH'. <br />, <br /> <br />PERHIT O~ ~PPLICC~TiON HO: 9~46B~3 <br /> <br /> ..... I:: ...RV.[,. I ~ EL_E!Z;TR]:CIAI,)/I,ILJH~d];R <br /> <br /> ITEH <br />SITRV;[CE/FEIi;;OER 1.,.ESS THAN 2~ AMPS <br />BR~],]{].-] C]]:~CU;[T., WITH SERV]'.CE OR FEEDER <br />ELECTRZCAL STATE $1.;R{]HAREE <br /> <br />~tJAN]'I'/Y <br />3 $:[50,,¢0 <br />&6 <br /> <br />$ :L 91.1}. ~) <br /> <br /> PAYEE::; 'a ,, <br /> I'.;~ECEIVED ,I. % Cl.., TYPE: Ci-IEbK ,!k, t~] <br /> <br /> ~ THIS IS NOT A PERMIT. THIS ~PPLICATION MUST ~0 THROUGH A ~EVIE~ PROCE~ WHERE THE <br />FOLLOWING MUST ~E COMPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ~SSURE TH4T <br />~LL NECESB~RY INFORMATION HAS BEEN PROVIDED, <br /> <br /> C.~.r, --, RV S,( ,q"-.:~ <br />P, IEb~at:~'KS~ 3-"21~B ,~MF' SVC 16 ...... ' ..... <br /> <br />CITY JLiRISD]:CT!Dt,]: BY .......................... D¢~'TE ..................... <br /> <br />FORM # MC 15-56 REV. 4¢~ OF FICE COPY <br /> <br /> <br />