Laserfiche WebLink
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 />I am performing work on a property I own or oocup¢, <br />I em 8 registered builder OR { ) the authorized representative SIGNATURE OF APPLICANT; <br />of a registered builder, <br />The work will be performed by a registered builder, <br />Other <br />I have read and agree to the terms stated on the reverse side of DATE'. <br />this document, <br /> <br />OWNER; TAX LOT'. I CATEGORY; <br /> WA I I S~ ,dR ~.?]!q ,'-! ! 3o-~72'"'6,:~4 I-d=S.I.:D=.NI .I. AL <br /> <br /> ,tit,. v, l, ... 973;?S N,~.~,.¢,I cOuliTY <br /> UO t , 749'"':[49',~ VALUATION: <br /> <br />TYPE: ON-SITE SF_I~Ar~E <br /> <br />(';OIqTRAC'I OR,¢ <br /> <br />WATFR SUPPLY: PW <br />'T'EST 14GL, ES READY: <br />SITE EVALUAT;(ON NUHBER~ <br /> <br />~REV]:OUS NO. BEDROOMS: <br /> <br /> TOTAL ASSESSED FEES <br /> <br /> ' B~4L.AIqCE' DUE <br /> <br /> PAYEK: RECEIPT NO: <br /> <br /> SEF, ATTACHED QOCUMENT FOR REQU~t~:'MENTS OF OI%'SiTE SEWAGE SYSTEM,, <br /> <br />, * THI~ IS A VALIB PERMIT ~ TH~S.P~RMIT ~XPIRES ~8 9A~ FROM ITS ISSUE DATE. IF <br />LO'd~F~;~UC]'J:ON F'~J:LS 7'0 )~EET ALL i:~E!QUI~EMEN'TS OF STATE LAWS AND ;'/ARIGN COUNTY BU~i D'i,~ .... <br /> <br /> ~'A!,I, I [;(:!Ur';"['"Y BfJT!]:'IN5 []F'F)'C;[AL / BY <br />t k,, ~,x (',D,' ," ~ .. ...... <br /> <br />OFFICE COPY <br /> <br /> <br />