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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 - <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />( ) of a registered bullder, <br /> I have read and ~gree to the terms ~ta~ed on the reverse side of DATE; <br /> <br /> i O~PANT LOAD: <br /> <br />X6~; .................................................................................. ~ <br /> PHONE: 76~-~364 VALUATION: <br /> <br />TYPE~ ELECTRICAL <br /> <br />CONTRACTOR~ NO. <br />LICENSE NO: <br />PIETROKs CLARENCE <br /> <br />PERMIT OR ~d~.ICATION NO: 9~5~31 <br /> SUPERVISINC ELECTRICZAN/NUMBE~ <br /> <br />PHONE: 76?-§364 <br /> <br /> ITEM <br />BRAHCH CIRCUIT. WITHOUT SERVICE OR FEEDER - 1ST CIRCUIT <br />ELECTRICAL STATE SURCHARGE <br /> <br />PAYEE: PIETROK, CLARENCE <br />RECEIVED ~Y~ MB <br /> <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY AMOUNT <br /> $1.75 <br /> <br />$36.7§ <br />$0.00 <br />$36.75 <br /> <br />BALANCE DUE $0.0B <br /> <br />RECEIPT NO: 60873 <br /> <br /> TYPE: CK CHECK t: 2148 <br />THiS IS HOT A PERMIT. TNIS~d~PLICATIOH MUST GO THROUGH A REVI£~ PROCESS #HERE THE <br />FOLLO#IHG HUST 9E COHPLETED. ~T IS THE.~ RESPI]NSI~ILITY OF THE ~PLIC~HT TO ASSURE THAT <br /> HECE~RY /HFDRH~TIOH HA~ ~H P~VI~. <br /> <br />PLAN REVIEW: BY ............. DATE ............. <br />REMARKS: Z/CIR <br /> <br />CITY JURISDICTION: BY DATE <br /> <br />OFFICE COPY <br /> <br /> <br />