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FOR CITY VAI.mATION] <br />Received by:. _ __ [ <br />Date: · [ <br /> <br /> MARION COUNTY <br />· !BUILDING INSPECTION DIVISION <br /> 3150 LANCASTER DR NE - SUITE C <br /> SALEM OREGON 97305-1398 <br /> <br />PERMIT NO: <br /> <br /> : Date: <br />14 [tr. ht~pecfi,~ff~lne 373-4427 <br /> <br /> .,.~ Office: Phone 588-$157 ..8:00nm - 4:30pm ' nod [~ ' <br /> <br /> Pl~o completo ~l ~floas, l throug .- ' <br /> 1. LOCATION OF ~~ON MARIAN Pt 11[1~la-dM: 1~ ~t(~h) Sm 1 <br /> <br />Job ~on: ALA~ B. ~ ~ P~, ~ ~{ mclu& ~ a=i~ ~ .~t~. D) <br /> <br /> PERMII~ ARE NON-~ FEg'ABLE AND EXPIILE IF WORK IS NOT <br /> STAR'II~D ~ 180 DAYS OF ISSUANC~ OR IF <br /> WORK. IS SUSPEi~DED FOR 180 DAYS. <br /> <br />2A. CONTP, AC'rOR IN~ALLATION ONLY <br /> <br />Electric*lComraclor RRTNR'R ROHF SECURITY <br /> <br />Addrm 8059 9.I4. Cirrus Dr. <br />mo.e~ (503) 641-0574 [ vax#(503)641-O9E <br /> <br /> FOR O~ <br /> <br />~y ~r ~1~ ~) <br /> <br />City/$ tat e~Zip <br /> <br />Owner's Signature: <br /> <br />3. pLAN I:LB¥1BW sr~CTION <br /> <br />Marion CoUnty does not require a pian reView. <br />We will prOvide'pl~ review rev/ice if you complete <br />seX:don 5B and submit tWo (2) sets of piaris and <br />SPeCifications with this applicatiOn. <br /> <br />$50.00 2 <br />$60.00 2 <br />S lO0.O0 2 <br />$1~0.00 2 <br />$303.00 Z <br />$40.00 2 <br /> <br />$~.~__2 <br /> <br />$35.00 <br />52.00 <br /> <br />$40.00 __2 <br />:$40.00 2 <br /> <br />$35.120 <br /> <br />$50.00 <br /> <br />sq. fi. x $.068 = <br /> <br />Al. Enter total oi' fee. s from S~ l g4 <br />A2. Add 5% surcharge (.05 X Al) $ <br /> 8ub~c~al <br /> <br /> ~T~ ~O~ D~ <br /> <br /> <br />