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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 performing work on a property I own or occupy. <br /> I sm a registered builder OR { ) the authorized representative SIGNATURE OF APPLICANT: <br /> of a registered builder. <br /> The work will be performed 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 /> DATF;: 08/0c//c??~ TIHE: t0:52:45 <br /> <br /> ' UC ON TYPE'. ~ OCCUPANCY; <br /> 9824 KE:ENE LN SE <br /> AUMSVILLE OR 97;%~5 <br /> <br />~ ~'-~ ~0',~i~':.: ....................................................................................................... <br /> <br /> sue~O HILLS F~UIF FAR~ 2 <br /> SAME ~ <br /> <br /> PHONE: ~64-].12~ VALUATION: <br /> i'~['8EE; ............................................ u <br /> <br />"YYPEa ELECTRICAL PERHIT OR BPPLIC~TZOH H0: ~4B9~7 <br /> <br /> COIqTRACTOR, NO,, SUPERVISING ELECTRICIAN/NUMBER <br /> LICENSE NO: <br /> THOMPSON~ HARILYN & DONALD <br /> SAME <br /> <br /> PHONE: 7~¢~4-11.~0 <br /> <br /> ITEi~ QUANTITY AMOUNT <br /> BRANCH 6I~6U]'F~ WITHOUT SERVICE OB FEEDER - 19T CIRCUIT I $~5,,8~ <br /> BRANCH ~IRCtJIT~ WITNOUT SERVICE: OR F~ED:~ EACH ADDITIONAL 1 <br /> EL, ECTR~CAI. STATE SURCHARGE <br /> <br /> : : REVIDUS: :RECEIPTS <br /> : THt:$ RECEIPT $J8.85 <br /> <br /> PAYEE: HARILYN 'FHO~PS~: <br /> <br />ALL HECESSAEy <br /> <br /> PLAN REVIEW: BY <br /> ATE <br /> ....................... CITY'JURISDICTION: BY .................. DATE ............................ <br /> REMARKS: 2/OlR ::' : <br /> <br />~ORM # MC 15,56 REV, 4/90 OFFICE COPY <br /> <br /> <br />