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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HiGH STREET NE <br /> SALEM1 OREGON 97301 <br /> <br /> PHONE: 588-5147 S:OO - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />lam performiflg work o, 8 property I own or occupy. <br /> <br />!OWN~: ; YA~ t_Of: ' CATEGORY; <br /> <br />LOT: I-¢ I I [3 q ::./,BL~O,~? ,,,,, ;,~ 4:¢ ~5 ~ECTIO N '. !TOWNSHIP: ~'~N~,E,!T' ]' 8 ~ ,~ ZONE; MAP: <br /> <br />TYPE~ PLUMiB,ING <br /> <br />PERMIT OR APPLICATION <br /> <br />::3AtfiE <br /> <br />]::'HONE; 74%-1;49,5 <br /> <br />BL}ANTITY A~OUNT <br /> 4 <br /> <br />RE'CE t F'T NO: <br /> <br /> Rf"CEtVF;D I_,Y~ Ct... ................................................................ I'YPE~ £;K CHECK 'l',l 1B:I. <br /> <br />~ THIS IS NOT A PERMIT., THIS APPLICATION MU~T ~O THROUGH A REVIE~ PROCESS WHERE THE <br />FOLLOWING MOST ~E CO~PLETE~. IT il~ THE RESPONSIBILITY OF TN~ APPLICANT TO ASSURE THAT <br /> Lt. NECEBSARY !NFO~MATIOR ~AS BEE~ PROVI~E~. <br /> <br /> V,.tl,, :f~Y t,'AT,.. CITY .h,¢ ].~,).~.CF,[QII,, BY J)ATE <br />:: ..... ?: 'l'),~ :~.¢. 'T '~?q.' <br /> <br />FORM # MC 15,56 R~-V, 4/¢,~0 OF FlOE COPY <br /> <br /> <br />