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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG NO 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8::00 - 4::90 <br /> 24 HOUR CODE-A-PHONE:: 588-7904 <br /> <br />OAf E: 10/}?/90 TINE: 16:50:24 <br /> <br /> P I LGRI M, ! HOMAS <br /> <br /> 840 7IH 5r <br />AUFFoVi LLE OR 97325 <br /> <br />USE OF BUILDING <br /> <br /> SIGNATURE OF APPLICANT <br /> <br /> TAX LOT <br /> <br /> CONSTRUCTION TYPE <br /> <br /> CONTRACT CITY UGB <br />AU~ViLLE <br /> <br />AUr~SViLLE, OR 9/392 <br />~ONE: 749-1843 <br /> <br />LOt BLOCK <br /> <br />NO <br /> <br />R~i DEN I IAL <br /> <br />OCCUPANCY <br /> <br />OCCUPANT LOAD <br /> <br />SiTE NUMBER: 11501 <br />VALUA'II ON: <br /> <br /> NO NO <br /> <br />TYPE: ELECTRICAL <br /> <br />CON 1RACFOR, NO. <br />LICENSE NO: <br />PI LGRIM, IHOIVIA,5 <br />P.O. BOX 633 <br />AUF4~ViLLE, OR 97392 <br />PH(.~x~E: 749-1843 <br /> <br />PERMiF OR APPLiCATiON NO: 28117 <br /> <br /> SUPERVISING ~LEC]RiCJAN/NUF~ER <br /> <br /> ITFJ~ <br />BRANCH CiRCUII$ - ONE <br />ELECIRiCAL 51ALE SURCHARGE <br /> <br />PAYEE: PILGRIM, FHOYflA8 <br /> <br />TOFAL ~EO FEES <br />PREVIOUS REC~IPIS <br />THI~ RECEIPF <br /> <br />OUANf'ITY AMOUNT <br /> $35.00 <br /> <br />$36.75 <br /> $o.ou <br />$36.75 <br /> <br />BALANCE DUE $0.00 <br /> <br />RECEiP'f NO: ~97'14 <br /> <br /> RECblVED BY: CL TYPE: iN <br /> THIS IS A VALID PERi'liT ~ THIS PERMIT EXpiRP~ 180 DAY~ FROf~ <br />~F~CTI~ C~ FOR ~ P~RIOD OF 180 OA~, OR IF ~$T~C?~ FAI~ TO MEST ALL <br />REdIReCTS OF STATE ~ ~D ~RZ~ ~NTY BUILDING ~O Z~iN60RDiN~C~, THIS PE~IT <br />~ALL 8E~E NULL ~O VOID. <br /> <br />REMARKs5: 1CIR <br /> <br />[X~A[_O E. ~JODLEY, MAR/ON COUNIY BUiLDiNG OF'FICIAL / BY <br /> <br /> OFFICE COPY <br />FORM # MC 15-56 R~V 4/90 <br /> <br /> <br />