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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OF{EGON 97301 <br /> PHONE ~88-~147 <br /> CODE-A-PHONE 4;30 P.M. - 8:00 A.M, <br /> <br />I an~ performm9 work on a property I own or occupy. <br />I am a registerer builder OR lhe authorized representative <br /> of a registered builder, <br />The work wiJl be performed bY a registered builder. <br /> <br />SfGNATURE OF APPLICANT; <br /> <br />TAX LOT: <br /> <br />OCCUPANCY: <br /> <br />SE <br /> <br />' UNITS; <br /> <br />NO ! <br /> <br /><~ ,.ARTNL;R <br /> <br /> iXE3T .~c'j 5~PNG~ <br /> <br /> ..... hP..~ ~[...a.,.. 8A:5~z FEE <br />:.: ........ ¢~:~ SLiP H;~RGE -ZONE <br /> <br /> .... " ~.~1¢~ .... RE;CEiP, NO .,v:' <br /> ,,, ,~ ...... ,,~F,: _~ ~YP6: C~. ~.Hc~. :~: <br />:": THI'S [S NOT A PE~IT. ~IS APPLICATI~ ~S~ ~ ~ A R~I~ P~E~ ~4ERE T~E <br />~OLL~ING ~ST BE ~PL~EO. IT i~ THE <br />ALL NEC~RY INFO~ATI~ H~ BE~ <br /> <br />OFFICE COPY <br /> <br /> <br />