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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:$0 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am a registered builder OR the authorized representatlve <br />of a registered builder. <br />The work will be ~erformed by a registered builder, <br />Other <br /> <br />I have read and agree to the terms stated on the reverse side of <br />this document, <br /> <br />~ JUF];DEN,~ bE. RN~RO & DE. BBIE ~ "~"~ ....... , <br /> <br /> I <br /> <br />j 33~ 6L, ESTER S'f' -- i CONTRACT CITY'. , UGa: :OCCUPANT LOAD: <br />i DE1 ROIT OR 97342 ~ETRBIT ;NO <br />~ ' , <br /> <br /> SAL. EH~ OR : SITE NUMBER: <br /> PFtONE:: 3'7]. -6,36 ,. VALUATION: <br /> <br />TYPE: PLUMB~N6 <br /> <br />CON FRA(, f OR,, Iq,O,. <br />JUE-;D~],h~ BERgArd) A DEBB;[E <br />990 .,AI....~ ~ .~4r~ ~v s <br />~AI.EH,, OR <br />F I,IONF: ~ ~7:[-6361 <br /> <br />ed~;.-LOCgTE9 RESIDENCE F'[XTUR~ <br />PI..UH~IN6 STA-Ft~ SURCHAR[E <br /> <br />PERNIT BR APPLICATION NB: 9~577~7 <br /> <br /> QUANTITY AMDUh~T <br /> <br />, , $20.00 <br /> $-I.25 <br />,: TO~AL ASSESSL-'D FEES <br /> <br />$0,, f;O <br /> <br /> PREVIOUS' RECETF'TS <br /> THIS RECEIPT <br /> ' ',: BA'EAN£E 'DOE: $*,,08 <br /> PA~EE= JUIEDEN,, }~EI:INAI'¢D & ZNVO~CE H0: 68269 <br /> <br />* THIS IS NOT A PERMTT. THIS' APPLICATION HUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWIN~ MUST ~E COMPLETED.:: [~ IS THE , RESPOHS[~LZTY OF THE APPLICANT TO ASSU~E THAT <br /> LL NECESSARY INFORN~TiON : <br /> <br /> F'LAN REVIEW: 'BY DATE CITY " ...... <br /> -. ................................................ JU~ISD].~llON: BY ....................... DATE: ................. <br /> <br />FCRM ~ MC ~ ~-~e n~'¢, 4,/~ OFFICE COPY <br /> <br /> <br />