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SENATOR BLDG, NO, 225 <br /> 220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 RM. - 8:00 A.M, <br /> <br /> I am performin9 work on a property ~ own or occupy, <br /> I am a registered t~uilder OR ( ) the authorized representative <br /> of a togistered buflden <br /> The work W~II be performed by a registered builder, <br /> Other <br /> I have read and agree to the terms stated on the reverse side of <br /> IRis document <br /> <br /> ;;):!~:"!; 39/: 2/;39 T;'.~!E: ',; ¢4: 29p <br />OWNER: <br /> .J CNN lNG'S, ?~E:V I h~ <br /> <br />Elf U8 ADDRESS: <br /> <br />s GNATURE Or App~ c*.T.~' W'1~2~¢~(~¢t~- --- ' (''~-' _ <br /> <br />TAX LOT: CATEGORY: <br /> t:,Z2 '_-?iN ;' <br /> <br />CONSTRUCTION TYPE: OCCUPANCY <br /> <br />USE OF BUILDING: <br /> <br />CONTRACT CITY: UGB: @OCUPANT LOAD: <br />~AR ION COUNTY <br /> <br />MA~LING ADDRESS: SUBDIVISION: <br /> <br /> S'i a,y'! ON 0',;: 9 ? i:} $ ? <br /> :::¥'!DNE; ?49.. !.323 ~fi,"3 SITE NLJJ¥~BE~: <br /> VALLJA~: ON: <br />LOT: BLOCK: SECTION: TOWNSHIR; RANGE: ZONE: MAP <br /> <br />Wl0tH~ OEPTH: AREA: UNITS: IRREG, LOT: CORNER: <br /> O. 50030 .~C YES <br /> <br /> }R ,~PPL. iOaT,~ON NO: '!S833 <br /> <br /> · ..,-,,r;.~:, ,,,,, :< N,'_?. S ;PERV];S~'NG ...... t:,(., X~(_',I,a,N/ ,, .~, <br /> <br /> :>0 E:OX -',¢ ~,) <br /> S"&Y'rON Ore 9?383 <br /> <br /> ...(~.b; St..IR(,H&~ ;~: '" (.NE 3 <br /> "~ "" ~' '~' : A:; .*L,". ~*.'~:~. <br /> <br /> TOTAL ASSESSED FEES <br /> 'f'H; S RECE; PT ~' ",' '-' <br /> 8~LANCE DUE <br /> <br />· : THiS iS A VALID PE~ZT · ~[S BEfiT ~P~RES, 180 DA%,:~ ~TS ISlE BATE. <br />C~STRUCTZON CEASES FOR A PER;OD OF 180 BAYS, OR ZF ,C~8T~CTZON FAILS TO ~EET ALL <br />REQUZR~TS OF STATE ~ ~B: ~[~ ~lN~ BUILDING A~D Z~ZNG ORDiNanCES, TH~S <br />~ALL BE~NE NULL ~D VOID. <br /> <br />FO"M ** MC 15-58 R6V H/88 OFFICE CO?Y <br /> <br /> <br />