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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG NO 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE:: 588-5147 8::00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />SIGNATURE OF APPMCANT <br /> DATE <br /> <br />DATE: 0//09/9] T£ME: 15:21;44 <br />S~ERLEY, IVAN <br /> <br />,~UMS¥ [ LLt OR 9. 325 <br /> <br />DSF Of I~DILDING <br /> <br /> TAX LOT <br /> 57 ~06/5 ~ ~O't <br /> CONSTRUCTION TYRE <br /> <br />OO'f~¥RACT CITY ' UGB <br />AUI'4~V i LLE NO <br /> <br />OCCUPANCY <br /> <br /> p?~. :? <br />OCCUPANT LOAD <br /> <br />MAILING ADDRESS RESIbENI ~AL ACCESDORY 5f'RUCFURE5 SUBDIViSiON <br /> <br />EVERECREEN ~O~fLE :SI~ I~:S <br /> <br /> 113'73 MILL CREEk{ RD <br /> Gt. IIV~Sv i LL~ <br /> PHONE: '769-7744 ~[~'~ NUMNER: 13254 <br /> V~LUAf ION: $1,00O- O0 <br />LOT RI OCK SECTION TOWNSHIP RANGE ZONE MAP <br /> <br />WIDTH DEPTII AREA :UNITS IRREG LOT CORNER <br /> ~b 9 l bOOS, SF NO NO <br /> <br />lYRE: 8UILOING PEf41~II <br /> <br />PLAN <br /> <br />OR APRLICAFiON NO: 3305~ <br /> ARCHiI~C~/~NGiNE~R. NO <br /> <br />OH ON E: <br /> <br />TOfAL ASSE~ED F~E5 <br />PREVIOUS <br />!HiS RECEJPf <br /> <br />QUAN f I ~ Y <br /> <br />AMOUNI <br /> <br />$29 'Cb <br />$ 29. / ~ <br /> <br />NAL.ANCW UUE $0 0O <br /> <br />WI:Ct:IvLLI BY: PB TYPE,' CHRCK ~; 0 <br /> <br />* !Htt~ iS ,-'.', VALID PERMif * THiS PERMII EXPIRES 180 DAYS FROM ils ISSUE [)A~t. tf <br />CONSIRuC!ION Ct;~E5 FOR A PERIOD OF 180 DAYS, OR iF CONSfRUCflON PALLS IO M~,.. AI.L <br />~Uil:~r'.-f'¢fl::.Nl':._ Oh ~TATE LA~ AND ~IAR[ON COUNTY b~UiLOiNG AND 7OI',IING ORDINANCES, ~HIS O~RMiT <br />5HALL IC!;CONI- NULt AND VOID+ <br /> <br />'JEIBACKS: PR 10 L3 lO E5 10 RR IL2 SP <br />R E.IVpJ4KS t GA ~i%GE/CARi~OR I ..... <br /> <br />OONALP k ~(]OOLEY, MARION C~UNiY ~UILOiNG OFFICIAL / BY <br /> <br />FORM # MD 15-58 REV 4/90 OFFICE COPY <br /> <br /> <br />