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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 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am a registered builder OR ( ) the authorized 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 and agree to the terms stated on the reverse side of DATE: <br /> <br />8778 ChoCADE HBY NE <br />SILVERTOI'I OR 97381 <br />I:'HON~.: 873"'7t 57 <br /> <br />SITE NUMBER= 94-ei925 <br />VALUATION~ <br /> <br />TYPE.' ELECTRICAL <br /> <br />COI~'rRACTOR~ I,lO,, <br />I,.,ICENSE <br />&l'lAY~ W'rLL <br />8778 CASCADE HWY NE , <br />~iLVERTON OR 97~8~ <br /> <br />BRANCN C.~RCUII'~ WI'FNOUT o~ <br />BRANCH Cir~CUIT~ WITHOOT SERVICE OR FEEDER:-~A~H:AO~ITIO~AL <br />E ECFECAI ,~FAF~ oMCHAkGc. ':': <br /> <br /> ,FEEs <br /> <br />PER~IT OR APPLICATION NO-- 57041 <br /> <br /> SUPERVISIIIG .~,E, OTR.[ CI AN/NUflBEFk <br /> <br /> I"AYLJZEr. M:¢AY,~ WILL <br /> <br /> THIS IS A VALID <br /> <br />REOUIREHENTS OF STATE <br />Sfl~LL BECOflE HULL ~H~ <br /> <br />$~00 <br /> <br />: RECEIPT NO: ,) ?,¢3Z <br />T~PE. [iA L;EIECK ~: 0 <br /> <br /> FROM IT~ ISSUE DATE. IF FALLS TO MEET ALL <br /> <br /> WOODLIEY,, MARION COUnTy BUILDING OFFICIAL <br />DONALD <br /> E. <br /> <br />OFFICE COPY <br /> <br /> <br />