Laserfiche WebLink
MARION COUNTY BUIb.*'~ING INSPECTION <br />SENAT(~ BLDG. 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 hsve read and agree ~o the tetdlS stated on the reverse side of <br />this document. <br /> <br />SIGNATSRE OF APPLICANT: <br /> <br /> DATE; <br /> <br />CATEGORY: <br /> <br />ODDUF'ANGYz <br /> <br /> ?0~13 S',Y't'EV'fLLE F',U NE <br /> :x.:,..'k,, ;: R a./0ON .A L 9 0 R <br />USE OF BUILDING: <br /> <br />OSSUPANT LOAO: <br /> <br /> NO. OF BEDROOMS: <br /> <br />MAIL,lNG ADDRESS: <br /> <br />SUSDIVISION: <br /> <br />SECTION: TOWNSHIP; <br /> <br />,~ ~ T~._ NLPflFSER: 838C, <br />.^NG~'i,Z~,LU,a,'r''~ Ol'~: ZONE: MAP: <br /> <br />NO NO <br /> <br />'Hv~.,, NC)DiLE !-lO'CF c'Er."v'l"r'. , C;~ APPLICATION NO: 901°~9~.~'~r' <br /> <br />MOETLE !,:ONE BASE' FEE <br />~OEr. LE HOHE STATE FEE <br />cL,.F.E-r St)RCH/.,~GE -ZONE <br /> <br />TOT,6L ASS:F_,.SSEB =~ES <br />DR~VIOUS RECEIPTS <br />--~IS'RECEtP~ <br /> <br />D,,~,LANC~ DUE <br /> <br />· ?HTS IlS NOT A P~F~TT. <br />FOLLONING MUST BE CONPLBTED. <br />ALL NECE'°o,.S~RY IN,~ION , <br /> <br />f;',EMAF, KS: fvlH PLA(,' EN~NT <br /> .... ,I .aCT[ON; <br /> <br /> PROCESS IRdERE THE <br /> iAPPL'rCANT TO ASSURE TH.a-"- <br /> <br />CiTY JJR.,=D ..... OK: F/,TM ' ~-i:' <br /> <br />FORMCMCl$-58 RE~11/a~ OFt:ICE COPY <br /> <br /> <br />