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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDO, NO. 225 <br /> ' 220 HiGH STF~EET <br /> SALEM, OREGON .97301 <br /> <br /> PHONe: 588-5147 8:00 - 4:,30 <br /> 24 HOUR CODE-A-PHONE: B88-7904 <br /> <br />OWNEB: CBN bEYF[..01::'MENT <br /> <br /> 12094 EH~,..,:~'I lTD <br />AURORA <br /> <br />USE OF BUILB~2 .... <br /> <br />OR 97¢C~2 qC¢/~N,c~OUNTY dJ~ <br /> <br />MAIUNG ADDRESS: ..... , <br /> <br /> ~:~:~].3 EHLEN RD FIE CONTACT 354-6611 <br /> AURORA OF( 9'7~2 JEFF 6ALLACgR <br /> PHONE: 678--1~K~8 VALUATION: <br /> <br />Lo'r: BLOCK: <br />WIDTH: DEPTH: <br /> <br />MAP: <br /> 4 <br /> <br />TYPE; ELECTRICAL <br /> <br />CON'ff;:ACTOR, I,lO. 08277 <br />L,: CEASE NO~ <br /> ,McCoy Elect'tic Co I~c <br />F0 Box 42428 <br />Po¥'t~and. 9~242--~g~8 <br />PHONE: 2~4-752J. <br /> <br />PERHIT OR APPLICATION Wi]: 9~5B295 <br /> <br /> SUPERVISING ELEC'f'R,t; C l AN/NUH~ ER <br /> <br /> ITEM <br />SER¥.EbE/FEEgER b:.SS THAN 200 ANPS <br />ELEI,,fR].CAL STATE SURCHARG£ <br /> <br />TOTAL, ASSESSED FEES <br />PREY I Ot.l~3 RECEIPTS <br />THIS RECEIPT <br /> <br />OLIAN'f 7 TY AHOUN'f <br /> $2,, 50 <br /> <br /> , ~ANEE DUE , ild~. 00 <br /> PAYEE: McCoy Ei,~ctric Co ~n~,~ ~.._J RECEIF~II NO: 52675 <br /> ..... ....... . ............ ........... ....................... <br /> * THIS IS HOT fl PERHZT. THIS APPLICATION HUST CO THROUCH A REVIEW PROCESS WHERE THE <br />FOLLO~IN6 ~UST BE COHPLETED. IT IS T~ RESPONSIBILITY OF THE APPLICANT TO AS~UR~ THaT <br />ALL NECESSARY INFORMATION HAS BEEN PROVIDED. <br /> <br />REI~ARKS: SEkVICE ONLY Y~$NO CIRCUITSY¢~ <br /> <br />cz'r¥ JURISDIC'f'ION: J~)Y ...................... DATE ........................... <br /> <br /> OFFICE COPY <br />FORM # MC t5~56 REV. 4/90 <br /> <br /> <br />