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MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br />AI~, Re~t~ · 'B. IF,~nAy .,,, .S~e~tor 8ullcll~ <br /> SII;am, Orego~ 97,30I <br /> <br /> 588-5147 - F:,~8-5148 <br /> <br />Type *f Pen~lt: ~ $11'~ ]~,¥ALUAT~ON O~LY FOR~ T,,,~ L*~ No; ...... <br /> <br />O~wc ¥~NC£NT PAVLZCEK, <br /> <br />97013 <br /> <br />Water Sopply: V~luatl0~: <br />S~w~g¢ Site <br />Dtt4~h Eval: Permit Fee:: <br /> No, <br /> <br />S~m: ............. ~ptic Permit Fee: <br /> <br />BTU:: <br /> <br />7O l, ~S tD <br /> <br />SIGNATURE OF APPLICANT: ~.. ....... <br /> PLEASE NOTEI Driveway end sidewalk Inq~ct, lans ~z~ ~utr~l by Publk: Works: 588-5036 <br /> Othe' Permits r~qulr~ by thl~ diet: Ptumblng E:~ Clectrle.l [~ <br /> <br /> <br />