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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 225 <br />~20 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 authorl~ed 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 8nd ~gree to the terms stated on the reverse side of DATE'· <br />this document· <br /> <br /> (BU'(£FO 4038A,~.~2 iRESIDENTIAL <br /> <br /> I CONTRACT CITY: ~ b~[ ~UPANT LOAD[ <br /> ~.,Jt. 8:~ HURRAY [,.~HE NE ~ ~ ' <br /> OR 978~2 MA;~)ON OOLNTY NO <br />AURORA <br /> <br />ZJ, 654 BUIfl'ING LN <br />AI,JRORA~ OR 97802 <br />PHONE: 678'-2219 ~ VALUATION: <br /> <br /> z <br /> <br />TYPE: ELECTEICAL <br /> <br />PAYf-_'E: KRIEGEI~. <br />RECEIVED BY: CL <br /> <br />PERHIT UR APPLICATION HO':. 9856?35 <br /> SUPERVISING ELE(:Yf'R I £!~: AN/I,[UMBER <br /> <br /> ITEM ~UANTITY AMOUNT <br />MANUFACTURE]) HOME SERV[,,E,,"~EDzR 1 $40.80 <br /> ., .... <br />ELECT'RIB~L SThTE SUROH~F, Cc '~ <br /> TSTAL ASoESSEDF'EES $4=.00 <br /> FREVIOU~ RECEIPTS <br /> THIS RECEIPT · $42.00 <br /> :' Ai: NCE' UE <br /> KEVtH (BU?ER) : <br /> · RECEIPT NO: 59446 <br /> TYPE: CK CHECK 8: 876 <br /> <br /> * TH'rs IS NOT A P£R~IT. THiS APPLICATioH' ~US1- E,,O THROUGH A REVTEW PROCESS WHERE THE <br />FOLLG~IN~ HUST BE COHPLETE~,=: '[T':~rs 'THE=: RESPOHS'rBTLITY OF THE APPLTCAHT TO ASSU~E THAT <br />ALL HECESSARY IHFORt~ATIOH HAB BEEH PROVI]DED. <br /> <br /> ~'I..~N i'~EVl'EbJ= BY ........... ~;.._.. ~TE. ................. CZ'fY JURTSDIO'flOIi: BY ............. DATE ............................. <br /> REMARKS: MS SVC <br /> <br />OFFICE COPY <br /> <br /> <br />