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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 />l am a registered builder OR ( ) the authorized representative <br /> <br />The work w~ll be performed 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 />SITUS ADDRESS; : CONSTRUCTION TYPE: j OCCUPANCY'. <br /> <br /> OCCUPANT LOAD: <br /> ~A~..O~ COUNTY <br /> NO OF BEaROOMS: <br /> <br /> ,aN ,,, '749.,.2(~7'9 ; VALUAT]:ON: <br /> ~ 4 ,. 44 At; ', NO NO <br /> <br />9~57761 <br /> <br />K~ATER SUPF'LY: F'W <br />YEST HOLES READY: YES <br />SITE EVALUATION NUHBEI~:;; <br />b-,X I,g ~ I N; TAN K vS i ZE: <br />EXIS'tJJ.I(; DR~]Zh FIE I) L]'.NESr, <br />SEP'f');C TANK <br />PREVIOUS NO. BEDROOMS: <br /> <br /> QU AIff' I T Y A~'iOU N T <br /> <br /> PREVIOUS RECEIPTS <br /> BALANCE DUE - ,- <br />:d .L,(v:~ ~¢Y,, ~s TYPE: CK <br /> <br />FORM # MC 15.56 R~%/. 4/90 OF FICE COPY <br /> <br /> <br />