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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 occupy. <br /> <br />I have read and agree to the terms stated on 1he reverse side of <br />this dooument. <br /> <br />OWNSR: *~' YAX* I" OT~ i OA"CE~ORY: <br /> CflHP(IEi_L · - <br />SITUS ADDRESS: , CONSTRUCTION TYRE: ; OCCUPANCY: <br /> , r~.--.3 <br /> <br /> ~ S~TE N~N~ER: <br /> <br /> :~ .L... ~ 0~ ,, <br /> <br /> J: 375"8234 <br /> <br /> F'R[<V Z,gUS REf;E'.i:PTS <br /> <br /> AN~ <br /> O~E <br />[.ONNECT~OHS ARE REQUIREI) TO BE COMPLETED UPON REQUEST FOR THE FIRST INSP.~CTZON. <br /> OF THE ITEMS ~RE IblCO~PLETE, AN:A~IT:ISNAL INSPECTION FEE NILL BE RE~UIRE~. <br /> ,EXTENSZON. PRIO~ TO TH~ [XPZRA~ION ~ATE OF T~E PERMIT. IF CONSTRUCTION FAX S T0 <br /> ALL REQUIREMEkl'B OF PT~T~ LAMB ~N~ H~RION COUNTY BUILdiNG AMC Z~NtN6 <br /> <br /> ~ h¢ ~: ,,,'" I,.' '. ~:' ~ ~.' :: ] ....... <br /> <br /> OFFICE COPY <br />FORM # MD I $,$$ REV, <br /> <br /> <br />