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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 688-5147 <br />CODE-A-PHONE 4::30 P,,M - 8::00 A,,M, <br /> <br />I am performing work on a property ~ own or occupy <br />lamat rog~stered builder OR( Itheauthorizedrepresentstive <br />of a registered builder <br />The work will be performed by a registered budder <br /> <br />' ..... ' "" ~ i)."E 02_72.: <br /> <br />SIGNATURE OF APPMCANT <br /> DATE <br /> <br />TAX LOT <br /> <br />CATEGORY <br /> <br />CONSTRUCTION TYPE <br />CONTRACT CtTY <br /> <br />OCCUPANCY <br /> <br />OCCUPANT LOAD <br /> <br /> NO OF BEDROOMS <br /> <br />MAILING ADDRESS <br /> <br />?i~E NL1MS~e- <br /> <br />1399 <br /> <br />LOY BLOCK <br />WIDTH DEpITH <br /> <br />EXISTING SYSTEM EVAL R°T. <br /> <br /> -TOTAL ~.~ESSEO FEES .": <br /> PREV I ~lS RECE l P-S. <br /> <br /> xE ~:' ' ': r',x, ¢- '"yq,¢ C~ CHECK ~ <br /> <br /> THIS iS A VALID PE~;T * ~lS PE~IT~P~ 36¢ DA~ F~ ITS ;~E DATE_ <br />U~STRUCT~ ~A:LS TO NEET ALL R~IR~TS OF S%AIE L~,~D ~RI~ ~N~ 8UI'LDI~G AND <br />ZF~ING ORD,N~CES, ~'S P~ALL ~E~ NULL ~O VOID. <br /> <br />· *X')Oi}:..{:Y. ~,'mqlON CDUNTY 8UtLONxiG O~!O~,~:~ /'~Y <br /> <br />OFFICE COPY <br /> <br /> <br />