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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 P.M. - 8:00 A.M. <br /> <br />I am performing work on a property I own or occupy, <br />I anl a~rggistered builder OR ) the authorized representative <br />of a registered builder. <br />The work will be performed by a registered builder, <br />Other. <br /> <br />OATE: <br /> <br />Situs ADOHEBB: i CON~TRUOTION TYPE: , OCCUPANCY: <br /> <br />MAILING ADDRESS: <br />t~Of: BLOCK: <br /> <br />SECTION; ~TOWNSH P~ : RANGE~ ' ZONE: MAP: <br /> ' '~ := 2h; ~,,'~ <br /> <br />-"}4:iS ,~ Er.' .'"." T; P r' ,., <br /> <br />.H_~ '-S A VALID PF_;~'VtlT ~ ~',4IS PE,:~IiT ~PiRES 350 OAYS F~ /TS i~E UATc. .r <br /> <br />~on~ ,, ~c ~:,.,,~ .~v e/s? OFFICE COPY <br /> <br /> <br />