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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 820 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />Other <br /> <br />I have read and agree to the terms stated on the reverse 8ire of <br />this document. <br /> <br /> ~ 5'-i,~ ' R'-'~ <br /> ~,~','~ 0L~,~i;~Y -~ ~ CONTRACT C~TY; ~ UGh; : OCCUPANT LO~D; <br /> <br /> ,::,AL. U4,~ OIr~ 97385 ! SITE NUH~ER: 94-81694 <br />FO b~ ........ ~'¢T~ ......... ~.~:' ....... ;U~TS , ~.~e, LOT; CO"'~: <br /> <br />TYPE: BWELLING PERHIT OR APPLICATION <br /> <br /> 90§4626 <br /> <br />AR C~l t TI:Z[; T/E big ~, ~E E R ~ <br /> <br />TO[AL ASSESSED t::'EE!~ <br />PREVIOUS RECEIPTS <br />THIS RE~EIF'T <br /> <br />BALAI~{;E DOE <br /> <br />~746.55 <br /> $0.00 <br />$746.5'5 <br /> <br /> P¢IYE:: R,'~:bh L ~]ut't:er !~7097 <br /> <br /> THiS IS NOT A PER~IT. THIS :APPLICATION HUST ~0 THROUGH A REVIEW PROCESS WHERE THE <br />FBLLOWIN~ HUST BE COMPLETED. IT~ IS' THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> <br />[.;],"i'Y J[JR,..¢,, ~ ¥1[.[ [,, <br /> <br />SETBACKS: F'R 2rzl <br /> LB--5 <br /> <br /> SE' <br /> <br />DA]'[ <br /> <br />~O~M # Mc ,~ R~V, 4¢~ OF FICE COPY <br /> <br /> <br />