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SENATOR BLDG, NO. 225
<br />220 HIGH STREET NE
<br />· SALEM, OD. EG~DN,.97301
<br />
<br /> PHONE 588-5147
<br />CODE-A-PHONE 4;30 P.M. - 8:O0 A,M,
<br />
<br />lamareglsteredbudderOR( ) the authorized representative
<br />
<br />The work will be pedormed by a registered builder,
<br />Other , ,,
<br />
<br />OWNER:
<br />
<br />SIGNATURE Of APPLICANT;
<br /> OATE;
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<br />TAX LOT:
<br />
<br />CATEGOR'~ CONNER[QAL
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<br />SITUS ADDRESS;
<br />56?2 V~LL, AGE
<br />Ad~oV~L,~ )R
<br />
<br />9?325
<br />
<br />SE
<br />
<br />CONSTRUCTION TYPE
<br />
<br />OCCUPANCY: ~.~;
<br />OCCUPANT kOAD
<br />
<br /> flO OF 6EOROOM$
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<br />MAILING
<br />
<br /> ;>HONE
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<br />SUBDIVISION ¥iLLAGE
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<br /> SITE NUMBER: 1823
<br /> VALUATION:
<br />
<br />LOT: ~.~(~ BLOCK:
<br />
<br />WIDTH; DEPTH:
<br />
<br /> .... ,;N I,',,A,~TOh:, NO,
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<br /> '5,-", v'E
<br />
<br /> PHONE: 362.-. 8/* $5
<br />
<br /> ];,,','.'Iv
<br /> T,'L, £ LO :NC PEE
<br /> r%~LDiNG STATE SLIRCt~ARGE
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<br />ARCH± E~,/EN~NE_R, NO,
<br />
<br />~HON E:
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<br />OU.,~NT;TY
<br />
<br />$; O,,~u-'
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<br />BALANCE DUE $3_ ,~'~,,
<br />
<br />;:W" ""' ',!": ', :;NVO[CE
<br />~,,,, ..... ¥=O JD TYPE; ,,.H~C~, ~:
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<br />~ THIS IS A VALID PER~,IlT * THIS PEI:~IT ESKPI~ 180 DAYS FROM ITS [S..S~E DATE. IF
<br />CONSTRUCTION CEASES FOR A PERIOD OF 180 DAYS, OR IF CONSTRUCTION FALLS TO ~E:,I~T ALL
<br />REOUIRFJ4ENTS OF STATE LANG AND MARION AND ZONING ORDINANCES, THiS PERt, t~T
<br />SH~,LL BECOME NULL AND VOID_
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<br />OFFICE COPY
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