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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97;301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588~7904 <br /> <br />I am performing work on S groge~ty I own or oSgupy. ' <br />I am a registered builder OR the authOriZed representative <br />of a regis ered bu der. <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 <br /> <br /> ~)184 GOLF CLUB E'b SE CONTRACT CITY: PANT LOAO: <br />AUHSVILLE OR 97325 HARI NO <br /> NO O~ BEDROOMS. <br /> <br /> SITE NUMBER= 9~-04~78 <br />PHONE: 74~'-2~8 ~ VALUATION: <br /> <br />TYPEt ELECTRICAL <br /> <br />CONTRACTOR, NO. <br />LICENSE NO: <br />FUSON, DES~DHD & E~ELYH <br /> <br />PHONE: 74Y-29&8 <br /> <br /> ITEH <br />MANUFACTURED HOHE 8E~' <br />ELECT~ICAL STATE SURCI <br /> <br />PERMIT OR APPLICATION NO: 9851678 <br /> <br /> SUPERVISING ELECTRILIAli/NUHBE~ <br /> <br />~AYEE: FUSON, DESNOND <br />RECEIVED BY: PM2 <br /> <br /> A THIS IS HOT A PERHI' <br />ALL HECESSARY <br /> <br />QUANTITY AMOUNT <br /> 1 <br /> $2.00 <br /> <br />$42.08 <br />$44.18 <br /> <br />$0.00 <br /> <br />RECEIPT NO: ~4124 <br />CA CHECK :~: Q <br /> <br />REVIEW PROCESS WHERE THE <br /> APPLICANT TO ASSURE THAT <br /> <br />PLAN REVIEW: BY <br />REMARKS: MS SER <br /> <br />D~[CI ION,.. .......................... <br />" '"' ' BY ............... I)A'l-lii: <br /> <br />FORM iii MO 15.5a RE'V, 4/t~S OFFICE COPY <br /> <br /> <br />