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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 58~5147 <br /> CODE-A-PHONE 4:30 P.M. - 8;00 A.M, <br /> <br />of a registered builder. <br /> <br />Other. <br /> <br />i have read and agree to the terms stated on the reverse side of <br /> <br />SIGNATURE OF APPLICANT: <br /> DATE: <br /> <br />TAX LOT. <br /> <br />SITUS ADORESS <br /> <br />CONSTRUCTION TYPE <br /> <br />CONTRACT CITY: UGB. <br /> ..,JL N NO <br /> <br />MAILING ADSRESS: <br /> <br />SUBDIVISION <br /> <br />CATEGORY: ....... <br /> <br />OCCUPANCY <br /> <br />OCCUPANT LOAD: <br /> <br />LOt BLOCK SECT)ON <br />WIDTH DEPTH. AREAJ <br /> <br />TOWNSHIP <br />UNITS; <br /> <br />SETE NUMBER: 2838 <br />RANGE ZONE: <br /> <br />TYPE: ELECTRICAL <br /> <br />PERf4iT OR iPPLiCATION NO= <br /> <br /> ] '"" ~:v; <br />'F ?al:; CCI;,iS'; 's~ <br />:,.,,~,77.T 3UF~C':-iAF:~GE ..-.;,/ONE <br /> :.:?:"i::.,?A,. SFq'TE :SURCHAS:GS <br /> <br />3482 <br /> <br />,~:,.~ A;'5$ESSEC FEE'S <br />..... /, O~. ,., RuC! <br />7!-:7S '="~'" - <br /> <br />C~ST~;CTZ'~ C~ FOR A : ~O0 OF ,80 DA~,; OR ~S~JCi,~ FAILS TC' :N;-c; ALL <br />:DfiALL BE~:E NULL ~ND VOID_ <br /> <br />.~.~, ~c ~-5~ REv ~ OFFICE COPY <br /> <br /> <br />