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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 />lamaregioteredbuilderOR( }theauthorlzedrepresentative <br /> <br />I have read and agree to the term8 stated on the reverse side of <br />th~s document, <br /> <br />$~ONATURE OF APPLICANT; <br /> DATE: <br /> <br />I ~:1H": [IH.S 0 N ,~ Ai'P)R C;,~ , RES:[DEN'T]:AL <br />['~i~b8 ~DIDRE~$: · CONSTRUCTION TYPE; OCCUPANCY: <br />[ 5-N <br /> <br /> ,~... ].J),:ilTJ,~l,,, ~(;(;ESSORY,,~TkUL]° .-. ''Lhd,.S':': <br /> <br /> HZLL CREEK ESTATES <br /> ;L39~ SW <br /> MJb,. ILL,,,,; OR 97~.,5 S~TE NU~DER: <br /> <br />TYPE: BUILDING PERMIT OR RPPLICATION <br /> <br /> I TEN <br />BU.T. LD:[ N6 FEE <br />PL.AH <br />-i'~U]:L.D]:NF,; S'f'AI'~-; SURCHARGE <br /> <br />A.qtCH T T E C'¥'/EN £,; :I hie E R, <br /> <br />PHONE: <br /> <br /> TOI'AL ASSESSED roE,: <br />: PREYJ:OU.B FIE ,gE lF'l'S <br />i: ~ THI'S RECEtPT <br /> <br /> · BALANCE ]DUE <br /> <br /> * THIS IS A VALID 18{~ DAYS FROM ITS ISSUE ])ATE. <br />CONSTRUCTION CEASES FOR DAYS~' OR IF CONSTRUCTION FALLS TO flEET AL~ <br /> EQUZ~EHEHTS OF STATE L~S.:AN~ :~AR~ON COUNTY BUILD~N~ AND ZONIN~ OROINANCES, THIS PER~IT <br /> ALL BECONE NULL AND VOID.: :. ' <br /> <br /> , HE G["I'~:: ~ SEI'E~ACKS: l::'t:~ <br /> <br /> : '~ . PrYI'[-,I~ : STORIES: ~ <br /> PLAN,, ACTION: R~::' :t.~.; <br /> ENERGY PATH: SP"' <br /> <br />!-,:h.}/AF:F.!:h,: [,¢~,~. 0 . T <br />!) r'lhl,,u ::,. <br /> <br />FORM # MC 15-58 RE'C, 4/90 OFFICE COPY <br /> <br /> <br />