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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG NO 22,5 <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 />Othor <br /> <br /> EVERGREEN PARK <br />SIT~S ADD~ESS <br /> <br />TAX LOT CATEGORY <br />CONSTRUCTION TYPE OCCUPANCY <br /> <br />RES 1 DEN I ] ,:~/. <br /> <br /> At. JC4SV i LLE <br /> <br />USE OF BUILDING <br /> <br />ON <br /> <br />CONTRACT CiTY UGB OCCUPANT LOAD <br />AUM.5¥'I LLE NO No Q¢ BEDROOMS <br /> <br />LOT <br /> <br />PHCN I'-''~ <br /> <br />VALU,~ l J~ON; <br /> <br />0_ NO N(,) <br /> <br />fy?.;::, t. LI;:CIRIC;AL PER~,i'/ OR APPLICATION NO: 9033585 <br /> <br />CON f/4A(..'iON. NO- 2?459 <br />!_ [-..'bN 5 b <br />R & R LLEC~RIC <br />~, C). ~0>~. b? <br />IURNEN, OR~iG'JN 9,':392 <br />R!~ONk; <br /> <br />SUPERVISING ~Lb[Jl RICIAN/NUFESER <br />RUSSELL RIC~ / I ~'/3-5 <br /> <br /> HOME L~ERVI CE/PEEOER <br />S~1E 5URCHARG~ <br /> <br />pay~::a: W & R E:LECfRZC <br /> <br />TOTAL A. bSESSEO PEES <br />PREVIOUS RECEiPtS <br />fHI~ R~CEiPT <br /> <br />QUAN ¥ [ T Y A?OUN t <br /> $35 0l.' <br /> <br />BAL.ANCZ DUE So OC <br /> <br />RECEiP~ NO: 35410 <br /> <br />* THIS IS NO7 A PER~IT. THIS APPLICATION RUST GO THROU6H A REViE~ PROCE55 ~H£RE THE <br />~OLLONING ~IUST BE COMPLETED. iT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECE~,SARY ~NFOR~A?ioN H/~SBEEN PROVIDED. <br /> <br />...... N R~'v'iEFh BY DAYE ................ City JURISDICIJiCN: BY ...... 0.,-',lo <br />REC%~RKS: R~t~6 I z~ <br /> <br />~OR~ ¢~ ~c ~5-~ .EV 4/~)o OFFICE COPY <br /> <br /> <br />