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MAHION ~r,)UN rY 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: 5~8-7904 <br /> <br /> an1 13erfotmlng work on a D(o;)erW r own or <br />I am a registered builOer OR ( ) the author;zed representative <br />of a ~eglstered buiIder, <br /> <br />TYPE= ON-STTi[ <br />PERtlIT ~ APPILI'CATI'ON <br /> <br />~ONTEACTOR~ <br />JEFFEEY~ CHABE , ':,, . <br />S~2e H~ ESTE~ ST <br />VANC0~VER. WA 98663 <br />PHONE. 2e~-&95-a96~ <br /> <br />WATER SUPPLY: CW <br />TEST HOLES, READY: <br />SITE EVALUATION NUM~ER: <br />EXISTING TANK SIZE: <br />EXISTING ~RA[fl FIELD LINES: <br />~EP~ZC T~flK ,PUMPED: <br />PREVIOUS NO. ~EDROOMS= <br /> <br />QUANTITY AMOUNT <br /> <br />FOLLOWING ~ST ~E CBMPLE~Eg,; ~T, ~S THE ~'RESPONB[BILITY OF THE APPLICANT TO A~SURE THAT <br />ALL NECESSARY [NFOEMATIOH~ HA~" ~EE~' P~OVIgE~. · · <br /> <br /> REMARKS~ PERMIT RENEWAL: NO F/V : I <br /> <br /> <br />