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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLD~,: NO. 225 <br />220 HIGH STREET NE <br /> SALEM, ~REGON 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 aproperty I own Or OCCupy. <br />t ~m S registered Puitder OR ( ) the authorized representative <br />of a [eglstered builder, <br />The work wifl be performed by a registered builder· <br />Other <br />I have read and agree to the terms stated on the reverse aide of <br />this document. <br /> <br />OWNS[Ri ' [ <br />I-~¥O'§'-AdDF~§~i ............................................................... ~o ~ s f~ U~Tib~-~'~¥~' ...............~ OCCUPAr~¢Y: <br /> <br /> .,8~7 CASE RD NE <br />AURORA OR 97082 <br /> <br />SAME <br /> <br />~5~+~dY ~?r~iMAR!ON COUN[~ I N0 ............. 0~ ................ ~OFX~ '~SXDi ..... <br />SUBDIVISION: <br /> <br />SITE HUHBER: 93-~394~ <br />VALUATION: <br /> <br />TYPE: ELECTRICAL PERHTT OR APPLICATION NO: ?~51347 <br /> <br />CONTRACTOE.~ NO, 4~327 5UPERVIS'rNG ELECTRICIAN/NUMBER <br />LICENSE NO. <br /> WIL~ONVILL. E LOCI( & SECURITY <br />PO BOX 517 <br /> <br />FHOHE= ~82-2323' <br /> <br /> ITEM QUANTITY <br />L,,I~ITE~ ENERGY ~ <br />ELECTRICAL STATE SURC~, I <br /> <br />AMOUNT <br /> $28.00 <br /> $1.80 <br /> <br />$21.08 <br /> $8.88 <br /> <br />PAYEE: <br />~ECEIVE~ BY: 9M2 <br /> <br /> * THIS IS NOT <br />FOLLOWING NUST.BE <br />ALL NECESSARY <br /> <br />PLAN REVIEW: BY <br />REMARKS: ALARM <br /> <br />FORM # MC I~-~ REV, 4/90 OFFICE COPY <br /> <br /> <br />