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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:$0 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am performing work on abroperty I own or occupy <br />I am a resistered builder OR the authorized represen at ve SIGNAT~JRE OF APPLICANT; <br />et ~ registered builder. <br />The work will be performed by e resistered builder, <br />Other <br />t have read and agree to the terms stated on the reverse side of DATE: <br />this document, <br /> <br />TYPE: ~UIL.DIM~ PERHIT OR APPLICATION <br /> <br />C 0 N TF.'~:,~C'[OR,~ NO,,, 42256 <br />,,~.I,E, V,,.I..L~ood Ih- ok <br /> <br />F H(?NE~ 363.--17J I <br /> <br />BL/I:I,.,P I N(; FEE <br /> <br />E',LU:I,,D1N(;; STATE SIJRCHARf;E <br /> <br />[ AY 1'-~ <br /> <br />54422 <br /> <br />P H II N I~ <br /> <br />TOTAL, ASSESSED FEE,,S <br />PREVIOUS <br />THIS RECEIF'T <br /> <br />(]UANT]:TY <br /> <br />A~OUNT <br /> <br /> $25.0,3 <br /> '$1 ,, 9Z <br /> <br />$65,. 46 <br /> <br /> Rii!:CEIVED 3Y: F'}' ; TYPE: C[ E[,,x' ~'-'" :[: 0 <br /> <br /> * THIS IS A VALID PERMIT. THIS PERMIT EXPIRES 188 DAYS FROM ITS ISSUE BATE, IF <br />CD~$TRUCTIOM CEASES FOR:A PERIOD:OF180 B,AYS, OR IFCONSTRUCTION FAILS TO.MEET ALL <br /> E,MOIREMENTS OF STATE LAWS AND HARION COUNTY BUILDIflG AMD ZONING ORDINANCES, THIS PERMIT <br /> ALL BECOME fl~LL ANB V9~9. <br /> <br />!}i],[E Ri; Y PATH:i <br /> <br />FORM # MC t §.~$ REV. 4/,~jO OFFICE COPY <br /> <br /> <br />