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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: 588-51,47 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> I am performing work on a property I own or occupy· ' <br /> I am a registered builder OR the authorized representative S GNATURE OF API~L <br /> <br /> work will be performed by a registered builder, <br /> <br />) ~ have re~d and agree to the terms stated on the reverse 6ide of DATE; <br /> this document. <br /> <br /> DATE: 06/22/92 TIME: 11:53:58 <br /> <br /> OR 9?342 <br /> DET~[ T <br /> <br />LO'r: <br /> <br />,WIDTH: <br /> <br />TYPE: BUILDING <br /> <br />CONTRACTOR, NO. <br />US FOREST SERV,[OE-CELLUL.AR O <br />, 09 , VE <br />f,-~OR'f'LaAlO, OR 97205-3~'08 <br />PHONE: 248-7491 <br /> <br />PLAN RE¥ i E~ 17 <br />BUILDING STATE SURCHARGE <br />ZONING SU RC,,'HARGE <br /> <br /> : PRL~V'ICIJS, RECEIPTS <br /> ]'HIS: RECEIPT <br /> At CE <br /> · <br /> <br />PERMIT OR APPLICATION NO: 9040788 <br /> ARCH 11'EC'T/EJ~G 1N EER, NO. <br /> <br />QUAN t' 1 TY <br /> <br />Af~OUNT <br /> $80.50 <br /> $52.33 <br /> $4.o3 <br /> $4.03 <br /> <br />$140.89 <br /> $0.oo <br />$140.89 <br /> <br />$0.00 <br /> <br /> 428~5 <br />CHECK ~: 588 <br /> <br />FOLLOWING MUST BE ~PLE~ED; THE R~SiB:iLiTY OF THE APPLIC~T TO ~RE THAT <br />ALL ,NECE~RY INFO~Ti~ H~ BE~, P~I:DED~ <br /> <br /> CITY JURi~Di:C'I'i~: BY DATE <br /> SEPTIC: BY m ~TE ~E~Y PATH: <br /> <br /> <br />