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MARION COUNTY BUILDING INSPECTION <br />SENATOR SLDG, NO, 225 <br />220 HtGH STREET NE <br /> SAL6M, OREGON 97301 <br /> <br /> PHONE: 588-5147 8::00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am a registered builder O~ I the authorized representative SIGNATURE OF APPLICANT ~,,~,~ <br />of a reg s ered builder. <br />The work will be 0erformed by 8 registered builder <br /> <br />OCCUPANCY <br /> <br />JOE (NAil,. REP'OR[ <br /> <br />l YPE: ON-5i ] ~ SENAG~ <br /> <br />PERMIf OR APF~LiCAfiON NOt 9035200 <br /> <br />CON [ RAC f OR, NO. <br />N,':'~l i REZ, JOE <br />LOPEZ, JOB (,A~,IL REPORI 10:) <br />12737 ~ALO L~P RD <br />~H~E: 578-2611 <br /> <br />WAFER ECJPPLY: <br />FESf HOLES READY: <br />5J,~rE EVALUAfc[r~ NUI~ER: <br />~Xi~fING f~K ~iZE: <br /> D~iN FIELD L~N~ ¢,.,~; <br />PRBVt~5 NO. BED~:''" ' ' <br /> <br /> i IEM _.¢ [.~AN r I fy AMC~JN ) <br />P-,~(iSfiNG 5YS1EM b'VAL. RPT. ~ 1 $11O_OU <br /> <br />TOTALA~%~EEx~EDFEE~ <br />PR~'N'[OJS RECEIPTS <br />THiS R~"CEIP7 <br /> <br /> $o.o9 <br />$~o_0o <br /> <br />'BALANC~ DUE <br /> <br /> PAY.Ch.;: LOPEZ, JOE A , REC[IPT NO: 37099 <br /> RECEIVED BY; c"l .................. ..,_ ....................... ~PE-* CK CHECK ~t: 164 <br /> <br /> SEE: A')I~HED ~UMEN] FOR ~E~'i~TS OF ~-S~IE ~E SYSTEM. <br />* THIS IS NOT A PE~IT. TH,/~;~I~TI~ ~ST',,"~ TH~ A 'R~i~ P~ ~ERE THE <br />~L~ING ~ST BE ~P~TED: ~'iT ~ ~HE 'R~IBi~TY'OF THE APPLI~T TO ~RE THAT <br />ALL N~B~ IN~Ti~;H~ B~ P~IDED <br /> <br />PLAN R~ViEN: BY ............... DATE]] ..................... <br />R~tARK5: LOAN REPORF R~2862 <br /> <br />CiTY JUR'ISDICTICNN: BY <br /> <br />DAlE ..... <br /> <br /> <br />