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MARION COUNTY BUILDING INSPECTION <br /> <br /> 3150 Lancaster Dr. N.E. · Suite C ° Salem, Oregon 97305-1398 <br />Office Hours: 8:00-4:30 · Phone: (503) 588-5147 · 24-HR Inspection Line: (503) 373-4427 <br /> <br />WORK DE~C <br />SITE ADDRESS <br />CROSS STREET <br /> <br />PARCEL NUMBER <br />OWNER NANF <br /> <br />APPLICANT <br />NAME <br /> <br /> PHONE <br /> <br />CONTRACTOR <br />PHONE <br /> <br />ELECTRICIAN <br /> PHOHE <br /> <br />SUPV EL E~ <br /> PHONE <br /> <br /> Units <br /> I <br /> <br />PO FOR LIMITED ENERGY FOR ALARM SYSTEM <br />10653 EHLEH RD HE AR CITY: MARION COUNTY <br /> <br />BUTTEVILLE RD NE/E. OFF YERGEN RD,999S BLK TO AR~HORTH SIDE <br /> <br />497S0-98~ <br />SPEER ELIZABETH <br /> <br />ADT SECURITY SYSTEMS IHC <br />7B3 HE HANCOCK ST <br /> <br />PORTLANB~ OR 97212 <br /> <br />ADT SECURITY SYSTEMS INC <br />284-3265 <br /> <br />A D T SECURITY SYSTENS <br />287-4S99 <br /> <br />OCCB: <br /> <br />Description <br /> Limited energy fee <br /> State surcharge <br /> Refund <br /> <br />CONTRACTOR LICENSE: <br /> <br />SUPERVISOR LICENSE: <br /> <br />aB59944 <br /> <br />26-289CLE <br /> <br />Fee <br /> <br /> Assessed fees : 21.90 <br /> Adjustments : .00 <br /> Total fees : 21.90 <br />PAYEE: ADT SECURITY SYSTEHS INC Total paxeents: 21.~ <br /> Balance Uue : .OB <br /> <br />1HIS IS NOT A PERIIIT. IT IS THE RE~POI~IBILITY OF THE /B~aLICNiT TO ~ T~T <br />~L ~Y I~TI~ IS ~SI~B ~ ~ ~IO ~ R P~IT ~Y ~ I~. <br />SIGNATURE OF APPLICANT: <br />******************************************************************************* <br />gONAIn E. WOODLEY, MAR)ON COUNTY BU)LDING OFFICI~ BY DSTO~U <br />-''-' ......................... ''- FOR OFFIC[ USE O~[V -'~--/-~t ............... <br />M~P: ZONE: PROPERTY LO.TOE: <br /> <br /> PLAN REVIEW: DATE: ZOflIHG REVIEW= DATE: <br /> <br /> <br />