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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 a registered builder OR the authorized depresentative <br />Other <br /> <br />I have read and agree to the terms stated on the reverse side of <br />this document. <br /> <br />SIGNATURE OF APPLICANT: <br /> <br /> O NER; , TAX LOT !~A~ORY; <br /> ,,,0¢,4 ,,:q"~ o~J~E ~'~,~ ~)~2 CON~RACT CITY: UGh; , OCCUPANT LOAD: <br /> <br /> [ SITE NU~ER: ~4-e~673 <br /> J 8~d:.. ~ VALUAI'iOI~= <br /> <br />;LOT; [BLOCK', ~ECTION,. ~TOWNSHiP,. ~ RANGE; , ZONE: MAP <br /> <br /> TY~>E: EL.ECTRICAL PERMIT OR APPLICATION NO; <br /> <br /> ],.,~,[,. .E...] <br /> <br /> P,[~ Bmx 724¢, <br /> <br /> ],[ TEN : ~lJA~" ' IT ',[ l' v A?[[~UN 'f' <br /> Z, hA1.C~.., C]~ [T, ,ET'. UY S;',V ~'O~:FT:EbE. F( - 1ST Ctf, CUIT <br /> <br /> ' TOTAL ~SSESSE9 FEES .,"~, ,, 75 <br /> PREVIOUS RE:~EI~rTS <br /> THIS RK(;E:EF'T '~,'"' ;,, 7,, .... <br /> <br /> J'AY'J':i:"~ Ke:l:,,;x,?~' Elec'briE: ]:~c:: ' ~ <br /> J.' <br /> <br /> ~g~!~m u~,n~5 EOR ~ FERIOD OF, 18e ~YSi: O~ IF CONSTRUCTIO~ F~ILS TO ~EEZ ~LL <br />o'gAl_.~ BECOM~ NULL AN9 VOl~; <br /> <br />OFFICE COi~y <br /> <br /> <br />