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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:S0 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />of ~ registered builder, ~ <br /> <br /> WELLS, JEFFREY ......................................................... ~[$_~[NTIAL <br />~ ~1~ AOD~: ................... ~ ~¥~TRUCTION TYPE; ~ OCCUPANCY; <br /> <br /> 12173 WEST STAYTON OR 97~25 IMARION COUNTY NO <br /> AUHSVILLE <br /> <br /> PHONE: 76~-7~86 ; VALUATION: <br /> , ...... mu <br /> <br />TYPE= ELECTRICAL <br /> <br />CONTRACTOR~ biO. <br />LICENSE NO: <br />WELLS~ JEFFERY <br />SAME <br /> <br />PHONE: 769-7386 <br /> <br />PERHIT OR APPLICATION NO: ?~48554 <br /> <br /> SUPERVISING ELECTRICIAN/NUMBER <br /> <br /> ITEM QUANTITY AMOUNT <br />BRANCH CIRCUIT~ WITHOUT SERVICE OR FEEDER - 1ST CIRCUIT 1 $35.80 <br />BRANCH CIRCUIT. WITHOUT SERVICE OR FEEDER - EACH ADDITIONAL i $2.~0 <br />ELECTRICAL STATE SURCHARGE $1.85 <br /> <br />TOTAL ASSESSED FEES <br />PRE,ViDUS RECEIPTS <br />TH!~ RECEIPT' <br /> <br />$38.85 <br /> $0.00 <br /> <br />$0.0B <br /> <br /> PAYEE: WELLS, JEFFFJ~Y_ ,v') RECEIPT NO: 50869 <br /> REC~?ED BY, MB ._~.~f~_~ ........................ TYPE, OK CHECK ~: 1818 <br />* THIS IS HOT A PERHIT. THZS,'~p~LICATIONHUsT ~ THRDU§H A REVIEW PROCESS #H~RE THE ...... <br />FOLLOMING HUST BE CONPEETED., ~T IS'THE', RESPOHSI~IL~y OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFORHATION HAS"])EEH 'PROYZD~9~ ' <br /> <br />PLAN REVIEW: BY .......... DATE ............. <br />REMARKS: 2/CIR FOR GARAGE <br /> <br />CITY JURISDICTION: BY ........ DATE ........... <br /> <br />FORM # MC 15.5~ R~V, 4/~0 OFFICE COPY <br /> <br /> <br />