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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 Of occupy, - .... <br />I am a registered builder OR ( ) the authorized representative SIGNATURE OF APPUC <br />0¢ a registered builder, <br />The work will be ~eNormed by a registered builder. <br /> <br />~" 'v - <br /> 86~+~Ub~lO~ TYP~: I OCCUPANCY; <br /> <br />' ALtROF~A, OR i~AR];OR COUNTY iNO ' <br /> <br />'0'~ 6~ ~kl ~6 i4~ ................ ": i ho, 0~ ~aoous: <br /> <br />................................................................................MAILING ADDBGSS; !-~0 ~o~i§i&~': ........................... <br /> <br /> I 8~TE NUi'tBER-" 94-~;~497 / <br /> <br />i / ~ 45, ~ AC N0 NO <br /> <br />TYPE: PLUHBING <br />) IIk~( 1%4, <br /> <br />PER~IT OR APPLICATION NO: 9857966 <br /> <br />T~TAL ASS~SSE;D FEES <br />PREVZOIJS RECE:[PT~ <br />TrI I.S ~F~CE,T. PT <br /> <br />BALANCE DUE ¢0,0;i~ <br /> <br /> FA..r_,, IX/YL,:., Pi RIECi, T. IF.'Ir J,lO: 68489 <br /> ,I ,F;r¥ D PY: as ..................................................................... T~?k,. CK CHECK ,a:: 72d5 <br /> ~ THIS ~S NOT A PERNIT, TNIS APPLICATION NUST 60 THROU~ A REVIEW PROCESS WHERE <br />FOLLOWING MUST BE COMPLETE~. ,, IT: iS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THaT <br /> LL HECESSARY iNFORMATION HAS BEEN PROVIDED. ' <br /> <br /> g', AN } ~.¢,;,W, Z~Y DATE · CITY JURI~DICT]:ON: BY DATE <br /> <br /> "i..Nfl~d(S~ WL, 5~.." ~'; ,%..' ,'"". ~ ''".. h,.'' <br /> <br />¢Oa~ ~ MC ~-~e Re,'. 4~ OF FICE COPY <br /> <br /> <br />