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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 8 registered builder OR the authorized representEtive <br /> o a registered builder. <br /> <br />I Olhor ..... <br /> <br />BROCK, CHORALES RESIDENTIAL <br /> A~RQRA OR ~78~2 ' MARION COUNTY; NO ~ <br /> <br /> SAHE <br /> SITE NUNB/~: 93-8~851 <br /> BHONE. 678-,~2~7 VALUATION: <br /> <br />TYPE: ELECTRICAL <br /> <br />CON'TRACTOR, NO. <br />LICENSE NO: <br />BROCI(~ CHARLES <br />SAME <br /> <br />PHONE: 678-52e7 <br />ITEH <br /> <br />PERHIT OR APPLICATION NO: 4965~ <br /> <br /> SUPERVISING ELECTRICIAN/NUMBER <br /> <br /> QUANTITY AMOUNT <br /> BRANOH 6TRCUITu WITHOUT SERVICE OR FEEDEI~ - 1ST CIRCUIT ! $35.00 <br /> BRANCH CIRCUIT, WITHOUT SERVICE OR FEEDEE EACH ADDITIONAL 4 $8.~8 <br /> ELECTRICAL STATE 8URCFIARGE $2. <br /> <br /> TOTAL ASSESSED FEES ~45. <br /> PREVIOUS RECEIPT8 $45. <br /> THIS ~ECEIF'T <br /> <br /> BALANCE DUE <br /> PAYEE: RECEIPT <br /> RECEIVED BY= PB TYPE: CHECK ~,: <br /> <br /> $ THiS iS A VALID PEE~IT ~ THIS PEE~I~ EXPIRES IEB BAYS FROM [~S ISSUE ~A~E. <br />CONSTRUCTION CEASES FOE A PERlO~ OF 18B QAYS~ O~ IF COHSTEUCTIOH FALLS TO MEET ALL <br />REQUIREMENTS OF STATE LAWS AND MARION COUNTY BUILDING AND ZONING ORDINANCES, THIS <br />SHALL BE~O~E NULL ANB <br /> <br />REMARKS: 5 C:[R <br /> <br />DONALD E. WOQDLEY~ <br /> <br />NARION COUNTY BUILDING OFFICIAL <br /> <br />BY <br /> <br /> OFFICE COPY <br />FORM # MC 15-56 R~V, 4/90 <br /> <br /> <br />