Laserfiche WebLink
MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NF <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-514T 8:00 - 4:;30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am perlorming work on a property I own or occupy <br />I am a registered builder OR ~e au hot zed rep esenta ve gIGNATURE OF APPLICANT; <br /> of a registered builder, <br />The work will be performed by a registered builder· <br />O,b , .... <br />I have read and agree to the terfllS stated on the reverse side of BATE; <br />th~s document· <br /> <br /> F,~t!?.'!!¢V)i ! F. !:IR 97;?¢'25 MAi-~:,;IilF, CdUNTY ',:tiE,' <br /> USE Of BUILDING <br /> <br /> MAILING AgPRESS r SUBDIVISION: <br /> ' SZTE HU~E~: ~4-~2&Z8 <br /> <br />~WIOTH; JDEPTH: AREA; : ................. UNITS: ' 'IRREG. ................. LOT: ~CO: NER'. ;~(~ (¢3 l;~ <br /> <br />CONTRACT CITY: ~ UgB: ' OCcuPANT LOAD: <br /> <br />NO OF 8EOAOOM$: <br /> <br />TYPE.,' ELECTRICAL <br /> <br />CI)I')TRAC')OR, 140., <br />L I CliiZN!~E NFl: <br /> ,,I LJ..,~k,., <br /> <br />PERMIT OR APPLICATION NO: 57'70i <br /> <br />, J )UI:. ,,' <br /> <br /> ]. FEb <br /> <br />Bkhk(.;H C1RL. U1 I,, WITHOUT ~F. kVt .,E. El., F!EEDER - E~,C.'H ADDITIONAL <br />, EC[~;:},,(L ~ITA'~E oJRCr)AJ-,I,E <br /> <br />~UANT! TY A N(:J[;;,i'i- <br /> $S,, 25 <br /> <br /> TOTAL ASSESSED FLEES ,~ ~¢; '~' <br /> PREVZ~US F:E :E',"PT$ ...... <br /> $68,25 <br /> ALANCE DUE ~;~,, ~ <br /> :'¢ YE'.,.: .E ' ,,'~, -,- ~: .(::' NORA <br /> <br />~ONS~R~ IS A ~A~I~ PER~IT ~ THiS PEr, If EXPIRES 18m B~ym .......................................................... : ..................... <br /> <br />A <br /> <br />OFFICE COPY <br /> <br /> <br />