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MARION OOUI~T..Y B~ILDING iNSPECTION
<br />'~EN/~f~R SLDG. NO. 225
<br />220 HIGH STREET NE
<br /> SALEM, OREGON 97301
<br />
<br /> PHONE 588-5147
<br />CODE.A-PHONE 4:30 RM. - 8:00 A.M.
<br />
<br />I am performing work on a property I own or O00Upy.
<br />I am a registered builder OR ( ) the authorized representative
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<br />TAX LOT: CATEGOC~YI
<br />CONSTRUCTION TYPE: OCCUPANCY:
<br />
<br /> a,.:¢,'O!.,,~/OO%~L.) O:,: 9 ~ CO~.
<br />USE OF BUILDING: ~f" ¢~--9 N.¢} NO OF BEDROOMS:
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<br />MAII. JNG ADDRESS: ........ SdBDIVISION;
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<br />2.'53 S. LOCUST
<br />SANSY, OR 978'!:3
<br />~','~'iONE~ 268-.5342 SITE NU~ER; 8388
<br /> VALUA? ~ ON:
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<br />WIDTH: ~ DEPTH: AREA: UNJTB: JRREG. LOT: CORNER: '
<br />
<br />NO NC
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<br />TYPE: PLU,~lS!NG PENNi T OR AP, =:,_,,.*,: iON NO: 9018921
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<br />2',',NT""',,~C~"Oq',
<br />I"iERN,&NDEZ, DAR,iD & ROSA
<br />25J S .J)CUST
<br />
<br /> ~ TEN
<br />"40%iL.E HOME SEidEF4 AND 14A'TER CONNECTION
<br />SLEET 3URCHAeGE ...-ZONE ,5
<br />PLUMBIN'C-', S"A'~E SE. ~,¥.>,;ttRO~
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<br />TOTA~'AS8ESSDD,?EEE8
<br />~RE~IOUS ~EC~,IPT$'
<br /> .HL~ REDE.PT
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<br />8ALPJ~CE DUE
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<br />~.'&YEE: FERNANDEZ,F~,F,~ & ROSA':~4AR{A iNVOICE NO; 20053
<br />RECEIVED BY: PF, _~r ~ ....... T~P~.,,,,;~i~ ,CHECK ~: c
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<br />* THIS ZS NOT A PE~ZT.
<br />FOLL~ZNG ~ST BE ~LETED. ,,:,ZT?,[S_~B , RE~S:,ZB~L~'~,':¢F,~E'APPLZC4~T TO ~E THAT
<br />ALL NECE~ARY ~NFO~TZ~ H~,'B:E~?p~v,zD~¢ ..... , ', .....
<br />
<br />, ~ .,~ .... 1,2¢. ~,
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<br />.o~,~c~s-s~ ~Ev-/se OFFICE COPY
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