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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 - 4:80 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am performing work pa a property I own or occupy· <br />lamaregi~steredbvilderORof a reD,stered builder, the authorized representative <br />The work will be performed by a registered builder, <br /> <br />I have read and agree to the terms stated on tl~e reverse side of gATE· <br /> <br />, [:f)Yi.]:;~, H ~ ¢/.E:S]:DE.T A <br />i ~ru~ ADOA~¢S; : 'OdbuP,*~6v, <br /> <br />~ ADRS~f, 8R ~AR:~ON COUNTY hO ' <br /> <br /> ~ SITE NUHBER: 94-~3497 <br /> F'1-.X'$~E; 67f','"7754 ~ VALU~'"~.Od,': <br /> <br />TYPE.' MANUFCtCTURED S'I'RtiCTURI=' <br />C 0 Ft 't.t:~ ¢4 C T Ltl:;:, <br />C¢,Y!,.¢L, ~ <br /> <br />PE~HIT BR APPLICATION NO: 9057965 <br /> <br /> Pt"IONE l; 698-'.-7954 <br /> <br /> ~AI,iUF:ACTLIREI) STRUC'I'URE I;"L~(Y;E~I::J*FT/CONI.[ECT~:Ohi ~. <br /> ~,llUk~.IUkb. 9 ., kbClh~. S'FAr~Z r. <br /> <br />~ TNZS IS H~T A PER~IT. 60 THR~uGH:~ REVIEW PROCESS :W~ERE THE <br />gQLLDWtNG MUST BE THE' RESPONSIBILITY OF THE APPLICANT TO ASSURE <br />THAT ALL NECESSARY INFORMATION HA~ BEEN PROVI, gE~. <br /> <br />FORM # MO 15-56 REV. 4/90 OFFICE COPY <br /> <br /> <br />