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-.'" 's'''• : .Marion County HE. <br /> ��, OREGON fidIIVE <br /> lag - NOV. 19as • <br /> . PUBLIC WORKS • A,b <br /> Building Inspection Division I <br /> REQUEST FOR_PERMIT , <br /> • EXTENSION/REFUND <br /> APPLICANT:./JA,Jc.r C eA ,.•►.) ' PRONE: 9 3 LC? LI - 33 '2 3.D . . <br /> MAG <br /> ADDRESS:,IO 6}o.i..• 63` ( 1-'74NS �4•Z • '737. ' <br /> (ADDRESS) (CITY&ZIP CODE)1 • <br /> PLEASE CBECK: )( , EXTENSION or REFUND <br /> PROJECT ADDRESS: 25 >3 K /J I:-c e t R.e. - .1-/opt 0 - '7,75' ' <br /> (ADDRESS) (CITY&Z I'CODE) <br /> • <br /> ACTIVITY N•U11)BER: 0 g - O,3 9 L/2• ¶ (c PcPI I e ct Ir • <br /> EXPIRATION DATE (PERMIT PLUS) -5 —c2 (7.- J.o /0 • <br /> REASON PROJECT NOT COMPLETED BY EXPIRATION DATE: <br /> /V v MoN<-y _ CI r /1-to !x r•-0 w,",fi-ez - • <br /> a-4-k ''��:, �.'1 a t c t, 14, <br /> 5 % $Qt oto 1iJ T1Le 5u me,y ._ ..__. _.._._ .__ __ ----- <br /> _. -_ .. __. <br /> EXPECTED DATE FOR COMPLETION: • <br /> PLEASE ALLOW 5 BUSINESS DAYS TO PROCESS EXTENSION.REQtJESTS AND ALLOW UP TO <br /> 3 WEEKS TO PROCESS REFUNDS. <br /> SIGNED: • - <br /> fix.'-eA -ed (p raD <br /> 0 ADMIN/FORMS/A-32 EXT RBQ FORM rev: 04/05—11/05 (0\k— .;„—. T f b 1 3.2q•2O A Q AO <br /> il • 9 21 • 2D i 0 . <br /> • Office (503)583.5147, . FAX (503)588-7948 , <br /> 555 CourtStreet NE • P.O.Box 14500 • Salem,OR 97309 • www,co,marion,or.us• • • • • <br /> Printed on recycled paper • Reduce.—Reuse—Recycle—Recover . • <br />