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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 22,5 <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 a registered builder OR ( ) the 8uthorized representative SIGNATURE OF APPL CANT <br />of a registered builder. <br />The work will be Derformed by a registered builder. <br />Other. <br />I h~ve read and agree to the terms stated on the reverse side of DATE; <br />this document. <br /> <br />, 55-~^¢T C,W ~ u~, 18~l~^.'r LO^O: <br /> 167~4 MILL CREEK RI) , , <br /> <br /> 363-628¢ - ~O~K ', SZTE NUN~ER= 94-~2638 <br /> ~ NONL. 749-2168 i VALUATION: $e.88 <br /> <br />TYPE: ~U'rLDIHG <br /> <br />KLEIN,~ MARVIN W <br /> <br />36/:~-6289 - WORK <br />PHONE: 749"2168 <br /> <br /> I l'~:~ <br />APPITIONAL BUILBIN6 EEES <br /> <br />PER~IT OR APPLICATION NO: 5634& <br /> ARCHITECT/ENGINEER~ NO,, <br /> <br />PHONE: <br /> <br /> QUANTITY AMOUNT <br /> $46.66 <br /> <br /> $46.06 <br />PREV~OUSRECEIPT$ $~,,~6 <br />THIS RECE~F'T $46.0~ <br /> <br />$6.00 <br /> <br /> fAY ....... KI_._,[i4 ~ MARVIN, W .8849 <br /> RECEIVE~ BY:~ PM : TYPE: CK CNECK <br /> ............................. zz::zzTzzz=z;;Zz=T~zz_==z=;~;~+:;:~ ............................................ <br /> ~ THIS IS A VALID ITS ISSUE DATE. IF <br />CONSTRUCTIOH CEASES FO~~ CO~STRUC:TION FALLS TO HEET ALL <br />EGUZREMEHTS OF STATE OR~IHANCES~ THI~ PER~IT <br />ALL BECOME NULL AND VOID.' <br /> <br />OFFICE COPY <br /> <br /> <br />