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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: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588:7904 <br /> <br />I ,am a registered builder OR ) the authorized representative <br />of a registered builder, <br />The work will be performed by 8 registered builder, <br /> <br />I have read and agree to the terms stated on the reverse side of <br />thi~ document, <br /> <br /> :8 .jRCH., ,JEI:'F <br />SITUS ADDRESS; <br /> <br />CONTRACT CITY: OCCUPANT LOAD: <br />gUMSV ZLI...E NO <br /> NO OF BEOROOM$: <br /> <br /> SITE <br />F' HOI,!E;i 769'--7744 i VALUATIOn: <br /> <br />TYPE: DUILg~NG PERMIT OR APPLICATION NO: <br /> <br />COI,fTRAC"FOR, biO., 42258 <br />Del Mc Com,d.c k <br /> <br /> ITEM ?. <br />BIJILI)IN6 FEE <br />PLAIq I;IFV t E~ '! <br />BUILDZNG STATE ,SURCHAF(6E <br /> <br /> 52298 <br /> <br />ARSH1, I..ST/[N~,.NLLI¢~ ],[0. <br /> <br />QUANTI'fY <br /> <br />A~IOUN'r <br /> <br /> $65,46 <br /> ~.6,~. 46 <br /> <br />?i ...., $ 0 ,, e 0 <br /> <br />~S <br /> <br />PAYEE': <br />RE(;EIVE'D BY: P3 <br /> <br />TYF'EI: CHECK ~[,: 0 <br /> <br /> ITS ISSUE DATE. IF <br /> FAILS TO ~EET ALL <br /> ORDINANCES, THIS PERMIT <br /> <br /> * THIS IS A VALID <br />CONSTRUCTION CEASES <br /> EQUIREMENT8 OF <br /> ALL 9ECOMENULL <br /> <br />t'_"IqEF(GY ~ .~TH,, <br /> <br />REHARI~£hl I.,AF,, il. *l At, iNIhlt; <br /> <br />DONALD E, WOCrDLE'Y, HARld'f;[ coiJl;iT~~ .... "~ ' "'" .-- - ¢.,, . <br /> ,~U.[L:O.~,q& (~1FI,.,.LAL / B ................................................ <br /> <br />ro~u # ~c ~-soa~v, 4~o OFFICE COPY <br /> <br /> <br />