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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG NO 225 <br />220 HIGH STREET NE <br /> SALEM, OF~EGON 97301 <br /> <br /> PHONE:: 588-5147 8::00 ~ <br /> 24 HOUR CODE-A-PHONE:: 588-7904 <br /> <br /> I ha~e ~oad and agre¢ to the terms statod Cfi the reverse Side of <br /> <br />DATE: 06/05/91 rU.1E: 1:~:12:12 <br /> <br /> NATIONAL I-:OREE>T LAND5 <br /> <br />5IT U ,S ADDRESS <br /> <br />~IGNATURE OF APPLICANT <br /> DATE <br /> <br /> fAX LOT <br /> <br /> 5-N <br /> UG6 <br /> <br /> HAL. L~ RIE)fS.E ~lvllvIi F 5f'- CONTRACT CITY <br />DET'RIOT OR <br /> 1'4A F~ J. ON COUNTY <br /> <br />NO <br /> <br />OE. IR.RNGR HCGO t~Ox 320 MiLL CtlY <br />~R NEThORK 1528 N~ EveRETT ~Rf~D <br />~ONE; 2~8-2262 SJ]E NU~BR: <br /> VA~A r TON t <br /> <br /> BLOOK SECTION TOWNSHIP HANGE <br /> 08 ~0 5E <br /> <br /> NO <br /> <br />CATEGOHY <br /> COfvfMERL;,[ Al.. <br /> <br /> 13049 <br /> $22,5(]8.O0 <br /> <br />ZONE MAP <br /> TC 10'~ <br />CORNER <br /> NO <br /> <br />TYPE: BU~(LDJNG PEP~if OR APPLICATION NO: <br /> <br />L;rjN 1RAC l OR, NO. <br />R(,)HN ~EN'tC ].AL <br />PO BOX 170249 <br />~ ~ RM i NGHAJ~ AL 35217 <br />PHON ~: <br /> <br />Pt.AN Risc iE~ <br />BUILDING 5TAI~ SUk'~HARGb <br />/.ON iNG SURCHARGE <br /> <br /> 9032411 <br />ARCHI'TgCT/ENGiNEER, NO. <br /> <br />TOTAL AgS~BS,~O P'~E8 <br /> <br />$~58.50 <br />$103.03 <br /> <br /> $?.93 <br /> <br /> $u_oo <br />$2 ~.ss <br /> <br />DUE $0.00 <br /> <br /> PAYEE: ~VIR NErI~CORK I~ 3451o <br /> REC~iVEO <br /> <br />· THI~ I~ Nor A P~Rl~ltf. FHa8 APPLICATION IYILIS[ ¢ THR~6~ A Rg~IE~ P~B~ WH~Rg ~HE <br />POLL~iNG MUSI BE CO~PLETBD. Il iS THE REdUCiBILiTY OF' THE APPLiC~I 'lO AS~R~ THAT <br />ALL NECE~ARY INPO~fi~ H~ BN~ P~V~OED. <br /> <br />CiIY JURiSDICIION: BY ...... DATE <br /> <br />RR 5P <br /> <br />OFFICE COPY <br /> <br /> <br />