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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 <br />CODE-A-PHON~,E 4:3Q~.P.M. · 8:00 A.M, <br /> <br />I am performing work on a property t own or occupy. <br />lama registered builder OR( ) the authorized representative <br /> <br />I have read and agree to ~he terms stated on th§ reverse aide of <br /> <br />U¢E OF BUILDING: <br /> <br />TAX LOT: CAYEG~RY: <br />CONSTRdCTION TYPE: OCCUPANCY: <br /> <br />LOT: <br /> <br />? (i ().-. 5 9 ~ !7: S l TE NUMB ER: ] 9 ? ? <br /> · ~ALUAT!ON ~ , It: <br /> <br />'TYPE: BUILDING <br /> <br />PERMIT OR AP .......... ;ON NO: <br /> <br />,~REV,~O~,~ "'=~ T <br /> <br />~¢A;~ANC E ,~b !47 <br /> <br />L¢ORM ~ MC 15~6 ReV ~/87 OFFICE COPY <br /> <br /> <br />