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MARION COUNTY BUILDING iNSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br /> <br /> 285 Church Street NE · Room 132 * Salem, Oregon 97301-3670 <br />Office Hours: 8:00-4:30 · Phone: (503) 588-5147 * 24-HR Inspection Line: (503) 588-7904 <br /> <br /> OH-~ITE APPLICATION <br /> D~TE/TIHE = e?/~1/95 14:42 ACTIVITY HO <br /> <br /> OCCUPAHCY : R-3 APPLIED : e~/ee/ee0e <br /> TO EXPIRE : <br /> PAGE <br /> <br />S~TE *BBREs$ : CITY: BETRO~T <br /> <br /> SUBOIVISION = NACKEY CREEK ADD LOT: I BLOCK: 5 <br /> <br /> ROS <br /> C STREET = GUY HOORE <br /> <br /> PARCEL,SIZE, = s25e.e SF <br /> <br /> HRHE : STEVENS,CHaRLES L-TRUSTEE <br /> ADDRESS = 12818. S~GAHORE RD <br /> LEAIJDOD, ES <br /> <br /> ~PPL[CRHT <br /> ~HE = PEDERSEN~ERL~D <br /> <br /> PHONE <br /> BEg CONTRACTOR= PEDERSEH~ERLRHO <br /> Z AGENT = PEDERSEN~ ERLAHD <br />....... P~HE <br /> ~ORK ~ESC : SE=FOR PROP 2~R RES <br /> <br /> site evaluation <br /> BEG ~rcharge <br /> <br />~EO LICEHSE= <br /> <br /> assessed fees = <br /> <br /> Tots! fees : 325.~0 <br />· Total pageants[ <br /> PAYEEc.PEDERSEH~:ERLAND Balance uue' . ~. <br /> <br /> THIS IS NOT A PERHIT. THIS APPLICATION HUST ~ THROUGH A REVIE~ PROCESS ~HERE <br /> ~O[L~FEA~AB~LI~Y AHD ~HSTALLAT~OH REOU[REHEHTS ~ CHECKED PRIOR TO THE <br /> OF A PERH[T.~T ~S THE RESPONSiBiLITY OF THE A~ICA~ TO ASSURE THAT ALL <br /> ~CESSA~ IHFORHATIDH IS ~I~. AS SO~ AS A~ REQUIREHEHT5 ~ THE REVZE~ <br /> <br /> SIGNATURE OF' APPLICANT: ........... ~_ . <br /> <br /> DONAIP E,, WOODLEY, MARION COUNTY BUILDIHG OFFICIAL / BY TNEAL <br /> <br /> ................ FO~ OFFICE USE OHLY. THIS IS HOT A PERMIT <br /> <br /> HAPc ZONE: ~S PROPERTY LO~TOR: <br /> <br /> <br />