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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 per¢orrt~ing work on a property I own or ocoupy. <br />I am a registered builder OR ) the authorized representative <br />of 8 registered bui der. <br />The work will be performed by a registered builder. <br />Other <br />I have read arid agree to the fern, s stated on the reverse side of <br />this document. <br /> <br /> 11673 EF.Eq EO ,RE: .... <br /> USE OF ~U~LDINGt <br /> <br />: MAILING ADDRESS: SUBDIVISION'. <br /> <br />BOX ~50 <br />ORE(:;ON CIlY OR 97045 <br />F'ttONE: <br /> <br />TYPE: BUILDING PERI, IT OR APPLICATION HO: ?a61~42 <br /> ~RCHTTECT/EN[~] NEE <br />BELOZER PO[JLTRY FARMS <br />PO BOX <br />OREGON CITY OR <br />PklONEx 656...6019 PHONE: <br /> <br /> I T E H <br />BUILDING FEE <br />PI,~N REVIEW ' <br />F'Zf~E AND LIPE 8AF'E~Y <br />BU],LDING STALE SUR[,HAR6E,::, <br />ZOI,] [ NE SURCHAF ~;E <br /> ,,:: , <br /> <br /> PAYLE,, <br /> RECEIVED BY: <br /> <br /> * THIS IS NOT ~ PERHI~ <br />FOLLONiN[ ~UGT BE <br /> LL <br /> <br /> ~[MING: BY FT~ <br /> "..': ........ "~'f ....................................... DA'['E"'~]'] ~ ~ ~ SI'OR[ES~ <br /> .~1 it( ......... <br /> P <br /> rY BY ...... D~TE_.~_ ...................~]4ERGY P~'TE ', <br /> <br />$434,, <br /> <br /> TYPE: CHECK i~: 8 <br /> <br /> A REVIEW PROCESS WHERiE THE <br />'THE APPLICANT T8 ASSU~E THaT <br /> <br />SE]TI:.~A Cliff = F:i:i <br /> !_. S <br /> <br /> R R <br /> <br /> OFFICE COPY <br />FORM/~ MC ~ 5.56 RE'V. 4i90 <br /> <br /> <br />