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MARION CouNTY'BUILDING INSPECTION <br /> 220 I4Jgh Street NE <br /> Salem, OR 97301 <br /> $:00 ~m-~i30~m ~c~t~ 588-5147 <br /> ~-A-~e 588-79~ <br /> ~F~ 588-7948 <br /> <br />COMPLETR ALL $ECT[ON$, 1 T~.OUGH 4 :,: <br /> <br /> 1.,,,~,,ob DescriptiOn .......... o.rage <br /> Reddenfial(X ) NeW(2~') ', :, p.~lacemem( ) (,¥) Attached <br /> CommcreiaI( ) New( ) Replaeernoat( ) ( !,Detached <br /> <br />~Manufactumf's -" Year of { ~].~ ~' '" Length: [Width5.7 { .... <br /> s..~,,: ,~-~qSo~~,,,~.,.: ,q~ L~,~: Rm } ,,, 5'2~. <br /> ',~,~ofs~.v wood'e,%~,~: Comp..,,,:,, s.+~-~= 3'~'7 ~:.~'~':, ~ ..... <br /> <br />4. Fee Schedule <br /> <br /> ¢) $tat~ Fee <br /> <br /> (4) ~g Su~e (lS.~ffa~lica~) <br /> <br /> C, Addltion al In spectj, c~ <br />20.00 = or ReinsFeeQoa <br /> <br /> D. Investigation Fee <br /> <br />$60,00 ::____ <br /> <br />on ghe r~v¢.-l'~ sid~ Of this form, Il ~ ~ <br /> <br /> Io <br />Signature of a~lieant: 0~, r ~a. Date t ' <br /> <br />se~ice o,' plumbing wa~r/sew~r ~e, am s~ate r~uimd pcm~its. [ ' ' MC 15-64 Rev 11,91 <br /> i ' <br /> <br /> <br />