|
MARION COUNTY BUILDING INSPECTION
<br />SENATQR 8LDG, 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 groperty I own or occupy·
<br />I am a registered builder OR the authorized representatwe SIGNATURE OF APPL CANT;~
<br />of a regbtered:-, builder.
<br />The work will be pe~ormed by a registered builder,
<br />Other
<br />I have read end egree to the terms stated on the reverse side of DATE: .........
<br />this document
<br />
<br /> '.~ ..... TAX ~OT: ..................
<br /> il: ,I1~ ,! ,, J)F4¥J~) I ~ F~...,.~..Z)l...~J .~ ~.,
<br />
<br /> ......... ~,.~ ~ CONTRACT CITY· UG~ OCCUPANT LOAD
<br /> 1:L692 W~:~B ::': , x NE , , , ·
<br /> ~H~RI(.)h COUNTY ! N0
<br /> AURORA % 9}'~i~2 ~ ...... k ............................ :
<br />
<br /> Rk.S I. JE~'~i .LA:,.. PCCESSOiRY , ,r M .... ~ ~
<br />rQ'~i~i~5 'X55~ ....................................... ~'~b'~i;i~iS~T ...................................
<br />
<br /> ..... , .....-, , .,.,, ; ~;~:,n~T,~.~%,
<br /> ,i.~:,..:;= 'C" NE4 ~,,~ :d~: -~.
<br />
<br />TYPE: BUILBI~G PERMIT OR APPLICATION
<br />
<br /> ]11 ~'E H
<br />
<br />PLAN REVIEU
<br />BUIL. Di{I'I(;; STATE S:.Ji;i'CHARGi{
<br />Z{:',N ii: N G EiLJFdCHAF/i;E
<br />
<br />F'aY::I~':; ,0A¥~[ ?qJi::H!,IAS"f'
<br />
<br />AI.',t, Ht l ECl/EN:::I Ni: ': !,~
<br />
<br /> I; RE.~,T d,. RECE':IPTS
<br /> ", 1,',~ '~ ::, ,.E,. 1" T
<br />
<br />SAI,,.~NCE DUE
<br />
<br />C~i. IANT :[ T Y
<br />
<br /> $86. ',:~
<br />
<br /> $4.33
<br /> $4.7,3
<br />
<br />$:151. ,.
<br />
<br />!b J. 7: I. 3 9
<br />
<br />5 4 5 4 3
<br />
<br /> d_.[,l._.,~,_.D i~ .....~ .... ,T'~I,,,., [.,K .,liE,,& ,~,,. t08
<br />
<br />~ TH:S 1S NOT A PERMIT. THI~ APPL:~ATrlON MUST GO THROUGH A REVIEW PROCESS WHERE THE
<br />FOLLOWING MUST ~E COMF'LETEB; IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT
<br /> LL NECESSARY IHFORMATION'HAS BEEN PROVIDED.
<br />
<br />z Y .)A .i. S ,0,,(..,ES=
<br />
<br />SF' 'B/f: CKS:
<br />
<br />FORM # MC 15.56 R~V. 4/~0 OF FICE COPY
<br />
<br />
<br />
|