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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 <br />CODE-A-PHONE 4:30 P,M - 8::00 A M,, <br /> <br />SIGNATURE O~ APPLICANT <br /> <br /> DATE <br /> <br />SITUS ADDRESS <br /> <br />TAX LOT <br /> <br />CONSTP(UCTION TYEE <br /> <br />USE OF BUILDING <br /> <br />S.m_ <br /> <br />CONTRACT CiTY UGB <br />~¢.A~,ON COl, I~'~v <br /> <br />SUBDIVISION <br /> <br />CATEGORY <br /> <br />OCCUPANT LOAO <br /> <br /> NO OF BBCROOMS <br /> <br />LOT BLOCK <br />WIDTH DEPTH <br /> <br />SECTION TOWNSHIP <br />20 0O00 <br /> <br /> 'v'~LLiA-TON: <br /> RANGE ZONE <br /> <br />9!3 ~!,~ ~m., <br /> iRREG LOT CORNER <br />~,~ NO NO <br /> <br />MAP <br /> <br />GERrY!f? Gq ,~po EC,BTE3N NO <br /> <br />'/'CEE 'COLT':::: O'~' S¢,.LEr¢ <br /> <br />'~ m'-{*'S IS A VALID PE~IT * ~IS PE~IT ~PIR~ ~O D&YS F~ ITS I~E DATE_ <br />CONST~CTI~ C~ES FOR A PER~OD OF gS0 BAYS, hOB IF ~ST~C~I~ FAILS TO <br />RE~ [RE~TS OF STATE T~ ~O ~RI~ ~N~ BUZLDING, ~D Z~ING ORDIN~CES, <br />SHALL BEdE NULL AND VOID <br /> <br />FORa ¢ Mc ~,,~ ¢,~. ,,'ee OFFICE COPY <br /> <br /> <br />