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MARION COUNTY BUILDING INSPECTION <br />SENATOR BL'DG N~. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4::30 P,M, - 8::00 A,M <br /> <br />NiKE'S ~vl()TL~L/E,~RL I%~CH,/~ELSON <br /> <br />StGNATURE OF APPLICAN'f <br /> DATE <br /> <br /> CONSTRUDTION TYPE <br /> <br />CATEGORY <br /> <br />OCCUPANCY <br /> <br /> !30 BREIT/NDUSH ROAD <br />':)E-RO[T OR <br /> <br />USE OF BUILOiN¢~ <br /> <br />97342 <br /> <br />CONTRACT CITY <br /> <br />OCCUPANT LOAD <br /> <br /> NO OF BE¢R00M5 <br /> <br />ryp,~ ..Ohi-S J TE <br /> <br />S[CTION <br /> <br />AREA <br /> <br />900208~, [ <br /> <br />H/~ r4!'4ON 0 <br /> <br /> S~TE NUMBER: 3¢5 <br /> vALUAT ] ON <br /> <br /> RANGE ZONE <br />10 SE <br /> <br />MAp <br /> <br />WATER ~LJP~LV: <br /> ~ .' ..... :: RE, DY, <br />St.~. EVA~UA ~ON NL t~-~. <br />~Xi,.>T~N¢ TANK ,~i~E, <br />~.XIS'TIN8 DR,~IN FIELD LIi~ES <br />SEPTIC T~NK PLI~PEO:: <br />PR~V!~dS NO, BEOR~'4S. <br /> <br /> l TENI <br />ON.SITE SYS < 1000 <br /> <br />· OTAL &,SSES,SED FEE,S <br />~REViou~ RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY <br /> $125.00 <br /> <br />5~25~06 <br />$'25 <br /> <br />RECi.:EIVE3 E!,Y C)~'~ .................................. TYPE: ~N CHEC~ <br /> <br />~ %~S.~S NOT A PE~T. ~IS APPL~TI~ ~ST ~ ~ A <br />~OLL~NG ~ST BE ~PLETED. %T ZS ~E R~SZBZL~ OF ~E APPLZ~T TO ~E .HAT <br />ALL NEC~ ZNFO~TZ~ H~ BE~ P~VZDED. , <br /> <br />OFFICE COPY <br /> <br /> <br />