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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG, NO. 225 <br /> 220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> lam a registered builder OR( ) the authorized representative <br />( ) Other <br /> <br /> PHONE: 588-5147 8:00- 4:30 <br />24 HOUR CODE~A-PHONE; 588-7904 <br /> SIGNATURE OF APPLICANT: ~~ <br /> <br />OWNER; <br /> <br />SITUS ADDRESS: <br /> <br />CONSTRUCTION TYPE: <br /> <br />,,¢:J <br /> <br />II&d,{jll~[::: : <br /> <br />SITE i"tU~BER: 92-- 05F~56 <br />VAL A'I lC)H:: <br /> <br />LOT: BLOCK: SECTION: TOWN~HIP: <br /> <br />WIDTH'· DEPTH: AREA: UNITSi <br /> ]... r..i C <br /> <br />RANGE: ZONE: <br />b~ <br />IRREG, LOT: ; CORNER~ <br /> <br />MAP: <br /> <br />NO. OF 8EORO0~S <br /> <br />904Z;S8 i. <br /> <br />I::'H Oi'4E :, <br /> <br />(;IUAN t' J '1Y <br /> <br /> BALANCE DUE $155..57 <br /> <br />FO/.LO~6 HUST ~ COUPLEr,S. ~T JS THE ~ESPONS~f~ZL~fY OF THE ~PPL~C~NT TO ~SSUR~ ~-~A~ <br /> <br />P L A h!. A(; i' ][ Ot'~ ;: i:;: I:' <br />ENE R(W PA'rH ,: <br /> <br /> CUSTOMER COPY <br />FORM ~/MC ~5-56 REV. 4/90 <br /> <br /> <br />