Laserfiche WebLink
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 />I am performing work on a property I own or occupy, <br />I am a registered bdlder OR ( ) the authorized representative <br />el a registered builder. <br />The work will be performed by a registered builder. <br /> <br />I have read and agree to the terms stated on the reverse side o[ <br />this document. <br /> <br />SIGNATtJRE OF APPLICANT; <br /> DATE'. <br /> <br /> I <br /> <br /> ~. 1~:~,¢ 1 Si E I NK~i;:' R~¢ SiE CO,r~ACT OTY'. ~ uee; OCCUPANT LOAD; <br />~ '~' , i~ OR 97825 ~ARZON COUNTYINO <br /> <br />i;;'HONE I', o'>, ,: 8 ..... "" ,'1 ? 6 <br /> <br />TYPE: DWELLIN¢~ PERMIT OR APPLZCATIOH HO: <br /> <br />F'HONiF; 769-7983 <br /> <br /> :[TEd <br />DWES.J,.'[ NG BUIi_D Z{,,~; <br />DWELL, tN(; F'LLJMBI N(~ <br /> <br />~Y~I;7.,,L]J,IG STATE SURCHARGE <br />DWELLING PLAN REV!E~ <br /> <br /> 9952162 DP <br />ARCH:t:'~'iECT/ENE;]:NEEF,~ NO,, <br /> <br />PI.-;0J,IF* <br /> <br />{,~ Al!f,[/Y <br /> <br />F'OLLOWZ~ MUST BE <br /> <br />AMOUNT <br /> $~68,, 46 <br /> $I 34.36 <br /> $Z3,. 47 <br /> <br /> SOl'AL AS$1""SSED. F'EES $~90., 26 <br /> PF~I!'V i0 L(S RECE ! P-F S <br /> THIS RECEi'P'~ ~d~9~, 26 <br /> <br />THIS APPLICATION HUST 60 TH~O[~GH A REVIEW PROCESS WHERE T~E <br /> IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSU~E THAT <br /> BEEN <br /> <br />FNERGY P~"f'H= .... <br /> <br />¢o~ ~ MC ~s-~ ~,. 4~ OFFICE COPY <br /> <br /> <br />