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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: 588-514,7 8:00 - 4:30
<br />24 HOUR CODE-A-PHONE: 588-7904
<br />I an3 performing wOCk on a propecty I own or occupy, ~~=_~
<br />
<br /> -, ,,, PANT LOAD:
<br />
<br /> , AM,J,.,¢ D~._LL, H~..~
<br />............................................................................................
<br />
<br /> BITE NUH~ER:
<br />
<br />TYPE; BUILDING PERHIT OR APPLICATION
<br />
<br />.,LL'~ [ k4 , L.k,,
<br />WCd,.7'.~ .~AHE~ P. & f'~A~OLYN
<br />
<br />90521B6
<br />
<br />:SUIL. DZN[; FEE:
<br />?LAM ::(EV:[ EW
<br />~:U :~L/} ]: NG .ST'ATE:
<br />
<br />TOTAL A,,,,DE,)S£D FL. LS
<br />F'.~;~EV I OUS RECF..IF'TS
<br />THIS RECEIPT
<br />
<br />AMOI./N T
<br />
<br /> ¢'99. :1.3
<br /> ¢~7, 63
<br /> $7,,
<br />
<br /> F.~YE' ..... WA-Z, ,,An,,,,~ t. & CAI((>,.YN o, ¥,,\ ,.~
<br /> ',::ECET.,:VEI) BY:~ L'N2 1'YF'~:: CK CHECK ~I~ 994
<br />
<br /> ~ THIS IS NOT A PErMiT. T~lS APPLICATION ~UST ~0 THROUGH A REVIEW PROCESS WH~RE THE
<br />FOLLOW~N~ frOST BE CO~PLETE~,, IT ~ THE RESPONSIBILITY OF THE APPLICANT TO ASSU,~E THAT
<br />LL. NECESSARY iNFORmATION HAS BEEN PROVIDED.
<br />
<br /> ~ ,_A~, k ,V,b...W,, ~ Y I)A'FE SZT~A:~',S:~'S~'..~'"~
<br /> ....... .~..~5~7~'~ ....... "' ~' '~'-"~ TGTAL S[~ FT:
<br /> J .OJ, iLo. '~ ....
<br /> ~ LAN, A[,~ iON. ~.~.~,.
<br /> ........................ P ' ' - 5.,'
<br /> ,,..- u. ,. :;, 'r 'T' ",,, ~(EI:(~;Y . A, H.
<br /> ..... 1Y J,.~. 1 ..~,0 .... L h, ~Y '~ , DATE .................................
<br />
<br />~ORM # ac ~s-ss R£V,,,~ OFFICE COPY
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