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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDEi, 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 />of e 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 /> <br /> DATE: <br /> <br />04/12/'89 r~ME: 1 .~ 59:55p <br /> <br />fvlAECTIN, KIN & D~:f/I~IE <br /> <br />RESIDENTIAL <br /> <br /> 11808 11'848 DUCKb. INN~;~AD <br />GERVAIS ~., OR 97026 <br /> <br />CONTRACT CITY; <br /> <br />COUNTY NO; <br /> <br />NO. OK BEDROOMS: <br /> <br />MARLING ADDRESS: <br /> <br /> 11848 DUCK INN RD NE <br /> GERVAIS, OR~ 97026 <br /> PHONE: 792-4259 :.::~:*~ <br /> <br />LOT: BLOCK. SECTION: ~WNSH~P: <br /> <br />SI'gE :NUMBER.- &643 ,; <br />..... YAiJ,IATiON ~ ........ <br />RANGE: ZONE: MAP; <br /> <br />:AC_,:,..::: NO NO:,::!:;,,, <br /> <br />18 <br /> <br />PAYEE: <br />RECEIVED ]BY: PR <br />SEE ATTACHED ~MENT FOR' <br />* THIS IS A VALID PF_,C~IT <br />(Z;~I~I'RUCTION FAILS TO <br />ZON~ Ot~[NANCES, <br /> <br />SITE EVALUATION NUIVI)ER: <br /> <br />~iSTING ~IN FIEL~]~;LIN~ <br />S~TIC ?T~K~PED= <br /> <br />::)~ANTITY ~ <br /> 1 $145.00 <br /> <br /> ::~F~ x .... $145.00 <br /> $145.00 <br /> $o oo <br /> <br />BALANCE $0,00 <br /> NO: <br /> <br />FO~M ~ MC 15-56 nEY 11/88 OFFICE COPY <br /> <br /> <br />