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MARION COUNTY BUILDING INSPECTION
<br />SENATOR BLDG. NO. 325
<br />220 HIGH STREET NE
<br /> SALEM, OREGON 97301
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<br /> · PHONE 5B8-5147
<br />CODE-A-PHONE 4:30
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<br /> I a~ a r~lste~ bull~ OR { ) the authorized fepresenlative 31GNA~RE OF A~PU~NT: .........................................
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<br /> ~TE = 08/30/8~ T~: 9: 04: 5~a ....................................................... , .................................... :
<br />~'6Wh~'n: H~Z~, .......................................................................... DEL ,
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<br /> ~ ............ C ....................... ~ .......... ~ L" ~ .....
<br /> 13793 ~L~ RD NE
<br />'. ~ OR 97002
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<br /> VA~AT I ~ ~ :
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<br />~;~'. ................... ~,: ................. A~[~ ...... u.~s~ m~. ~o~ ~ :co,~ .
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<br /> ~PE= ~[TE S~ HATER ~PPLY:
<br /> ~ lEST ~ R~= Y~
<br /> ~I~I~ T~K SIZE:
<br /> ~T~, ~. ~ISTI~ D~[N FIELD LIN~:
<br /> H~I~, DEL
<br /> ~E P~[~ NO. BED~
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<br /> ~E:
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<br /> IT~ ~TI~ ~T
<br /> 5E < 6 ~ OLD '. ,.~,..,,,. 1
<br /> SITE ~ALUATI~, FI~T ~T
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<br /> & · .'" ."ER~Z~.R~E~': .. $2~5.00
<br /> ~'~' ....' '. "~..,':~.B~P~.~ :., ': "', $o.oo
<br /> /..-~ · . ;, , /,,,,, '..] ..,.--,..-.:,.,.,.¥ ,,, ,, ,,,, ,, :.;,...
<br /> ~'~ "'. .... ' ..... ,',~?~":.~'" ,' 2.".
<br /> PAYEE =
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<br /> SEE A~ED ~T mR R~I~.~i~,,~, ~,'-'."'
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<br /> R~R~= S~TE ~AL & ~PTIC FOR ~. :~":-='~05~ .,
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<br />~-oR~ ,~ MC ,S-S~ ..v, ~.? OFFICE COPY
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