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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 225 <br />220 HIGH STRI=ET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 ~/ ~/~......~ <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br />b/~l ~m performing work on 8 property I own or occupy. <br /> I nm a registered builder OR the authorized representative SIGNATURE OF APPLICANT: <br /> Of a registered builder. <br /> <br /> Other <br /> <br />i OWNER; .... TAx LOTi ...... <br /> OA .... 0,/. //,4 i'. .... UZL: ~;) ~',9,o <br /> CONSTRUCTION TYRE: i 6CSOD~NOY <br /> <br />~i'b+H: '~bE~h~ ~ A~'~X] ! UNITS; ; CORNER; <br /> <br />14ECHANICAL <br /> <br /> Gf'/RY <br /> <br /> 749 -:t.;:~95 <br /> <br /> tv&NS ~ ORYER <br /> OR ACC~:SE;OFIY (NOT <br /> <br /> SLATE SI.]i~CI"IARGE <br /> <br />(;~LJANT t TY <br /> 1 <br /> <br />SRO,, 0~ <br />~f; ]. 8 ,, '~ ~.~ <br /> <br /> ; Ar' ........ ~IALI,_,.~tROM~ /;ARY RE:CEIPT NO: 5701~1 <br /> RE.f.:I~:t, VJ:iD BY~ C{, ' ': ....... <br /> .................................................................... FYFE,. CK CHECK q. l~!:L <br /> <br /> ~ THIS ~S NOT A PERmiT. ~'~4~8 ~:I~TI~ ~' ~O THRBW~H A REVIEW PROCESS WHERE T~E <br />~OLLOWING MUST ~E COHPLETE~. ~T IS THE RESPONSiBiLITY OF THE APPLICANT TO ASSURE THAT <br />LL NECESSARY IHFOR~IATIOH HAS BEEH PROVIDED. <br /> <br />........ . )A-rEO¢,TE ...................... <br />[, It ,. ,...qi?Cl:lllh, ~'~ ..... -. <br /> ~., .., f)l)l;!.:4 . ~ ,. .......... <br />d .....x. , F:X J t & '~?A'f'H FA;ii ................ <br /> <br />OFFICE COPY <br /> <br /> <br />