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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 RM, - 8:00 A.M.
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<br />I em performer19 wOrk on a property I own or occupy.
<br />I am a registered builder OR the authorized representative
<br />of ¢ registered builder.
<br />The work wilJ be performed by r~ registered builder.
<br />Other __
<br />
<br />~ ?,? !<LEZL RT!
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<br />SIGNATURE OP APPLICANT:
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<br />CONSTRUC,CION TYPE: OCCUPANCY:
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<br />MAILING ADDRESS:
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<br />SUSDIVISION:
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<br />LOT: 8LOCK: SECTION: TOWNSHIP:
<br />
<br /> '¢,S, LL/AT; ON:
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<br />IRREG. LOT: CORNER:,,. ~.
<br /> NO
<br />
<br />MAP;
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<br />"-¥o¢: ELECTRICAL PERF!!T ('iR ;¢~PPI,..TS.~,'~'i~ON NO:
<br />
<br />-ZONE
<br /> SL, F~ r'~ RSE
<br />
<br />THIS
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<br /> . - ............................................... '~' ,~,~ ..... T-- ...... , "' ........ --'7' ~'"'"~'~'~',""--'-%~"~"'" .............. ' ............... ; ................ ~ .......
<br />+ "HIS IS A V.4LID PERNIT ~ ,;.,,T, HI'$, PER:~4I,T EXpI'RES 180 DA,Y$ FC~OM I't'S zS.S_IE DATE.
<br />CONSTRUCTION CEASES FOR A, P~R;~OD :OF ,180 ,DAYS,,' OR,IF:,CON~,T, RLICTL'-~t FA'~LS TO ~EET ALL
<br />RE~IREH~TS OF STATE ~ ~'D"~I~ ~N~ BU'IEDZNG A~D Z~ING ORDIN~CES THIS PE~T
<br />SHALL BECONE NULL ~O VO~B. ",,',:' ..... : , ' ~ ,
<br />
<br />¢, r,v/:-. ,.,% ",~...¢v,.;, c,t~2327 ,
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<br />~ 0,,~..,3 ': :,'~i(}O,'?..E¥ v?'!,:L{,~!'i COLNTY SL,,~I.,©~ ~G O I=~ ........,-~'~,i / !EIY
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<br />FORM ~' MC 15.5({ REV 11/88 OFFICE COPY
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