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MARION COUNTY BUILDING INSPECTION
<br />SENATOR BLDG, NO. 225
<br />220 HiGH STREET NE
<br /> SALEM, OREGON 97301
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<br /> PHONE 588-5147
<br />CODE-A-PHONE 4:30 RM, - 8:00 A.M,
<br />
<br /> I am performing work on aproperty I own or occupy.
<br />
<br /> ,
<br />1AT?': 09/'! :3/89
<br />
<br /> R, ,,..H,.,~R D.~, ~,&YSE L
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<br />~.,': '~;, E LEVEL.ANr: cT %..E,
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<br />MAILING ADDRESS:
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<br />,~N~_., FAM]'LY DIKE~.LINC:'S
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<br />SIGNATURE OF APPLICANT:
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<br /> DATE: __
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<br /> TAX LOT:
<br /> 57711-000
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<br />?,L!MSV T LLE NO
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<br />SUBDIVISION:
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<br />RES ~ '3 E ".i
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<br />', 80X 105
<br />/'..,~I,=V ....... OFt c ~ '"o,''
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<br />2 ,t~
<br />
<br />8S
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<br />Si`TE NU¥IBER: I rS?
<br />Vt.,,L[JA'T ~ON: $! 2. COO
<br />RANGE: ZONE: MAP'
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<br /> NO NO
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<br /> 'TYPE; 8UIL. DING
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<br /> '}(~NTRAC'~OF4, NO. 578¢,'~0
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<br />993 EAST !~OWELL
<br />~ONMOUTH (3~ 9738 '/
<br />, PHONE'. 838,,-3 159
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<br /> PLCE7 S/IRf?R.~RG~ -ZONE 3
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<br />· ERMI, OR APPLICATION NO:
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<br />AF~,H I TECT/ENG ! NEE R. N(,3 ..
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<br />RH ON E:
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<br />TOTAL A~SESSED
<br />PRE~IOUS RECEZPTS
<br />
<br />BALANCE OJS
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<br />QLIA!'¢ T l 'f"¢
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<br />· .,, ,, ~ :[., L ..S T,P~: CHECK
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<br />" "4~,,~ 'S A ~' .... .c~.~?.l`T ~' -~ ' ~'~' ~'"~'~
<br />"O',?RUE"] '.k CEASEf~.FOR A?ERIOO: OF ~80 DAYS, OR I~ CQNSTRUCTIOF~ P~,~LS
<br />'::":'L f::,ENZNT3 OF ST.-,. E LAWS ,A~0 ~ARZON COUNTTM BLI;LD~NG AND ZONING
<br /> '->,6. ,,I. ~ECO'viE NL.U AND VOID ' ' , '
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<br />PLAN. ?<',T '[ ON:
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<br />~o~M · ~c ~-~ ney ~,~ OFFICE COPY
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