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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 F~M, - 8:00 A.M.
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<br />SIGNATURE OF APPLICANT:
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<br /> DATE:
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<br />°w~l~.T E:
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<br />CONSTRUCTION TYPE;
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<br />CATEGORY:
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<br />9/O 10TH c,
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<br />~ONTRA~T CITY: UGB:
<br />.,'ALrMSV I L, LE NO
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<br />O00UPANT IJDAD:
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<br /> NO OF 8EOEOOMS:
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<br />MAILING AF20RESS: SUBDIVISION:
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<br />,¢'"',- E/OX '18,5 GJ~LOOIX
<br />c ~, ¥'r'r', ~,,, 9?385
<br /> ~ 89- ~ 354 SITE i',!UMSER: ,,,, * ¢8
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<br />WIDTH: i DEPTH: '1 AREA: 25 UNITS: ~S IR~G' LOT: 2[~I GORNEH; ~S 5
<br /> '7 O '~ 98 q¢ YES ~, -
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<br />CONTRAC'RD~, NO 3: 2
<br />EMERY & SONS CONS'!~
<br />PO ?,OX 393
<br />STAYTON, ORE 9?383
<br />oHONE ,, 789-775 ~
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<br />,C*ERMi'F OR APOLZCATiO['~ .%'0:
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<br />'!8789
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<br /> ITEY ( ANT /kY~Ot..IN T
<br />~4ATER LINES, '[ST :O0 FEET
<br />SE~ER LiNCS, 1St !30 ~EET
<br />~'.,EBT SU~CFARGE -,-ZONE 3 $3,84
<br />oI,j..~/,~ P,'K} STA~E SURG"!A&S¢
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<br />TO'FAL ASSESSED FEES
<br />,°REVIOL}S ~EG/IPTS
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<br />BALANCE*U;;"=; '!'1~,* ~/r~
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<br /> ........ ~Y: C'! F~PE;.{<IN ,CHECK ~: 0
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<br />~oJ~OTI~ CE~ES FOR A '?EE,t, ODV,}bF ,lB0', ,DAYS, OR IF ~STRUCTI~ FALLS TO MEET A~L
<br /> E~IREM~TS OF STATE ~: ~D'~R~::~NTY BUI~DING,~D Z~ING ORDIN~CES THI- PE~IT
<br />~ALL 8EC~E NULL ~D VOID'. "'t , ..... , .... -
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<br />""r"}hc~..3 FF ~OODL. Ev, %~.q.[ON COUNTY 8U!LDING OF¢iO!/~L / 8Y ..............................................
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<br />FORM ¢~ mc 18,B6 REV 11~0 OFFICE COPY
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