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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 pertormed by a registered builder, <br /> Other <br /> I have read and agree to the terms stated on the reverse side of DATE: <br /> this document. <br /> <br />r'~ ,;~(,(J FT,~ TON' ........................................................ - ~ ZA~f~7-'g~ <br /> 515 1ST N <br /> <br /> ~ ~ ~ ~, .......................... <br /> <br /> PO BOX 594 <br /> AU~SVlLLE OR ?~325, ~I~E NQ~BE~: <br /> PHONE: 747-~4~7 ~ALUATION: <br /> <br />TYPE: ELECTRICAL <br /> <br />COI`I T R,A,,C T 0 R,~ HO. <br />LICENSE NO: <br />SCOTT,~ TOM <br />PO BOX 594 <br />AUHSVILLE OR 97;,~25 <br />PHONE: 74%-,"~407 <br /> <br /> Z[TEM <br />SERVICE/FEEDER LESS THAN ~8~ AMPS <br />BRANCH CIRCUIT,, WI'T4 SERVICE OR FEEDER <br />EL. EC1R[OAL STATE ~URCH~RGE' ' <br /> <br />PERMIT OR APPLICATION NO: <br /> <br /> ,.~UF ,r,,RV I S I NG ELECTRICIAN/NUMBER <br /> <br />F~UAFIT ]:TY AMOUNT <br />1 $50.00 <br />11 $22.00 <br /> $3,60 <br /> <br /> $75.60 <br /> <br /> TOTAL ASSESSED FEES <br /> PREVIOUS RFCE!P'f'S <br /> '?HIS RECE]:~T 7 <br /> A ,ICE I) J; <br /> <br /> * THIS [8 ~ VAL]~ PERH~T * TN~8 PERHIT EXP[RE8 DA~8 FRON IT8 ISSUE ~TE. <br />C8N~TRUCTZON CEASES FOR ~ PER~O~ OF 180:~AYS~ OR IF CONSTRUCTION F~[LS TO ~EET ALL <br />REQUIREMENTS OF STATE LAMS AND HARIOH COUNTY. BUILDiNG AND ZONING ORDINANCES, TH~S PERMIT <br />SHALL BECOME NULL ANOVOID, <br /> <br />:~ EMARKS:: <br /> <br />DONAL.)) E,, <br /> <br />200AMF' !]ER kELOCATE Al`il) :I.I/CIR ALT' <br /> <br /> WOODL,.EY,~ MARION CO[JMTY BUILD:I:NG OFFI(]IAI,., / BY <br /> <br />FORM # MC t I~-~$ REV, 4/'~0 ~'E COPY <br /> <br /> <br />