Laserfiche WebLink
MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG. NO, 225 <br /> 220 HIGH STREET NE <br /> SALEM, ORE~ON 97301 <br /> <br /> PH(~NE 588-514.7 <br /> CODE-A~PHONE 4:30 P.M. - $:00 A,M, <br /> <br />lan performing work on a property i ow¢~ or occupy. <br />I am a regtstered builder OR ( ) the authorized representative SIGNATURE OF API~LICANT <br />Of a registered builder, <br />The work will be performed by 8 registeCed builder, <br />Of her <br />I have read and agree to the terms stated on the reverse side of DATE: <br /> <br />'SITUS ADDRESS: i CONS'rRob~IO~ TYPE: ~ OCCUPANCY; <br /> <br /> ....... E '~ ~ 'v'-~ ","' ~-- ~ CONTRACT CITY: UOB; OCCUPANT LOAD: <br /> ~ ' '- C~ ~ ?,3 2:3 ~ ~ <br /> <br />MAILING ADDRESS: <br /> <br /> ::;!-.Iii: <br /> <br />LOT; ,8LOCK: <br /> <br />::::.:::, .~., ..\,..-~',~ ~.,(.~.,e,::,.~, :~_~,-. -~E~.~.._~.:. ~::!,~H ~ $ ,~V,~, c.Y.' . <br />*:~H*e"~ IS NOT A PE~[T_ ~S APPLICA~2~ %H~ A RSVZEW P~E~ W~ERE THE <br />ALL .,,,_CE~ARY iNFC~,TI~ ~: <br /> <br />,,...~t..,,~ ~.;:l~,~[!~:: ",' % ,,~ - -,~ ~ .... , <br /> <br />OFFICE COPY <br /> <br /> <br />