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MARION COUNTY BUILOlNG INSPECTION <br />SENATOR BLDG,, NO. 225 <br />22,0 HIGH. STREET NE <br /> SALEM, OREGON ';j7'301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am ~,e,tormm~ work on a property I own or occupy <br /> <br />IO~h~'r ....... lo the terms staled ~1' 't~e reverse side of <br /> <br /> 11~54 J~ NAY ~ CONTRACT CITY <br />~N ILL6 OR 97~25 <br /> <br />1'1~01 $IEiNK.~4P k'OAD S~ <br />PtflONt~: 749-1225 ~i'¥'E NUIV~R: 11550 <br /> <br />I, ?4 AC YP,,~ NO <br /> <br />48 <br /> <br />1YPE: C~N-~}IE ~E~GE <br /> <br />5lit; EVALUAflON. EA. ADOL. LOf <br /> <br />PRE~JI~ RECEIPTS <br /> <br />(~IUAN r i [ Y AM~UN 'f' <br /> $~45.00 <br /> <br /> BAL~OU8 $O.uu <br />PAYbb: LONG, NI~LiA~ ~ P.~CE[PT NOr <br />f~ECglVED BY: L~42 , ~ _ .... ~y .. fYPg: OK CHECK g: 3929 <br /> <br />....N~O,.1._~:-~._T_H.I~. ~__ N_O_T ,.C-~NT OR IMPLY PERMiE~IQN TO ~UILD ON THiS F~ARCEL. PLANNING AND <br />C.UN~NUUIZUN pERM~[T~/r~ijs..r BE IDBTf~ED BEFORE BUiLDIN(~ OR SEPTIC INSTALLATION BEGINS. <br /> <br /> R~tvL~.R~,~: SiIE EVAL. R~,q.4'f5 <br /> <br /> OFFICE COPY <br />FORM # MC I ~,5~ REV ~90 <br /> <br /> <br />