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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 <br />CODE-A-PHONE 4::30 PM - 8::00 AM, <br /> <br />f 8m a registered builder ORI ) the authorized representative <br /> <br />The work will be performed by a registered builder <br />Othe( <br /> <br /> I have read and agree te the terms stated on the reverse side of <br /> <br /> ;'l~"E tS/2C/E>? T ?rE-: !J:23:SSa <br /> <br />SITUS &OGRESS <br /> <br /> 130 BREITENSUS~-I ROAD <br /> <br />USE OF BUILDING <br /> <br />SIGNATURE OF APPLICANT <br /> <br /> DATE <br /> <br /> TAX LOT <br /> CONSTRUCTION TYPE <br /> CONTRACT CITY <br /> <br />UGB <br /> <br />MAILING ADDRESS <br /> <br /> S~TE Ni?BEq, <br /> <br />SECTION TOWNSHIP RANGE ZONE <br /> :2 ~E <br /> <br />I CT BLOCK <br />W~DTH DEPTH <br /> <br />OCCUPANCY <br /> <br />OCCUPANT LOAD <br /> <br />1945 <br /> <br /> MAP <br /> <br />TYPE: ON'-SITE SEWAGE <br /> <br />P'_"R'v'i' '"",,-, , L_C,A ION NO; 2251 <br /> <br />MATER SUPPLY: <br />-EST ~OLES <br />SZXE 2~ALUaT~ON NUMBE~ <br />EX;ST~NG TSNK <br /> <br />P~'VIOL~S NO. EED!~OOI~S <br /> <br /> ': CC'i"~ $Y5 190~. % ',- <br /> <br /> '.12 PREVIOUS RE~E~ c,-_-' <br /> '"" >';S ',,.7 ~E <br /> <br /> , .c,,,,_-- r-¥ D:v, rio'E: IN 04¢C,*' a <br /> <br />'~ THIS TS A VALfD PER~"4$T * ,Hi,,.,S PERMIT. 'EXP];RF_.S .3,8,0 OA,S FROM !TS IS,.c~E BATE_ <br />OC~STRLICTION FAILS TO I,.1~ET AL. REq!JIRI-:~TS OF STATE L&h,~ a~40 f~C, RiON COUN'TY BUILDING ,aND <br />ZONING ORDINANCES. THIS PERMIT SHALL 8EO~E NULL .~D' <br /> <br />OFFICE COPY <br /> <br /> <br />