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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 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am performJn9 work on a property I own or occupy. <br />lamaregisteredbul~derOR( ) the authorized representative <br />of a registered builder, <br />The work will be pedomled by a registered builder· <br />Other <br />I have read and agree to the terms state(J ~'ihe"revel:~'sid~ ~f <br />this document, <br /> <br />,,~,,,,,g~f:E: 07/08/91 'I:i. ME;! '~.2.:.20.;O.1 <br />~ ..... ~: TAX LOT: CATEGORY; <br /> <br />: S TUS ADDRESS~ CONSTRUCTION TVP~: OCCUPANCY: <br /> <br /> D~T~I135f' BUTTE S'f' OR 97342 N ~ ............. <br />us~ 0F ~U~'dS~-: )~$~¢ :~-'~ .............. ;.~e: ~:'"~6~F&;; ..... <br /> '. <br /> <br />1633 SE 3?fH <br />POR1LAN0, OR 97214 <br />PHONE: 235-0916 <br /> <br />t CT ! ~LO~K: i SECTION: <br /> <br /> 31 ' 3 '1 1 <br />:WIOTH: IDE ~H: , AREA: <br /> I ; <br /> 83i - 245o. <br /> <br />fYPE: PLUmiNG <br /> <br />PERNI[ OR APPLICA'fiON NO: 38255 <br /> <br />CONIRACTOR, NO, <br />HAINES, JULIUS <br />1633 SE 3'?FH <br />PORTLAND, OR 972~ <br />PHONE: 2~5~0916 <br /> <br /> iTEM <br />WArER LZNE$, l$'f 300 FEET <br />NOBILE HOME SENER AND WATER CONNECTION <br />PLUrCt3~NG S'fA'fE ~URCHARGE ,: , <br /> · <br /> <br />PAYEE: <br />RECEIVED BY: P8 <br /> <br />QUAN'I'I'f'Y Ar','Y6)UN'T' <br />1 ~20.00 <br />1 $25.00 <br /> <br />TYPE: C~ECK ~: <br /> <br />$4'?.25 <br /> 47.25 <br /> $0_00 <br /> <br />$0_00 <br /> <br />COHSTRUCTIOH ' OR A ~RIOD OF ::':1:80 ~,. OR :;16¢'~CTI~ FAI~ TO M~T ALL <br />~IR~TS OF STATE ~ ~0 ~Ri~.'~ 8Ui~::;¢~D::~iNG ORDIN~C~. THiS ~IT <br />~ALL BEdE HULL ~D ~iD. :"' .:' ;:r;.'::'.:.::':'::"?::;:~:::~';:: <br /> <br /> D~ALD E. WOODLEY, ~R[ON COUNTY BULLOZN <br /> <br /> <br />