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MARION COUNTY BUILDING INSPECTION
<br />~ATOR 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.
<br />
<br /> I have reed end agree to the terms stated on the reverse side of
<br /> ~Bis document.
<br />
<br />OWNER:
<br /> .':, ..... 2,, A'Z
<br />
<br />:,:, 4 E;AR~..E'," w; SE
<br />
<br />UBE OF BUILDING:
<br />
<br />MAILING ADDRESS:
<br />
<br /> TAX LOT;
<br />
<br /> ¢ONSTRUCTtON TYPE:
<br />
<br /> CONTRACT CITY'.
<br />',,',,6, ¢,' ! ON CCUNTY
<br />
<br />OCCUPANCY:
<br />
<br />NO. OFB~DROOMB;
<br />
<br /> ,.A: Y !',/15G.
<br />
<br />LOT: BLOCK: B~C¥1ON: TOWNSHIP:
<br /> 3
<br />WIDTH: 0EP'rH: AREA:
<br />
<br />MAP:
<br />
<br /> 52
<br />
<br />L%;N T R,¢.C'%)~;', NC
<br />LIOEiNSE N0:
<br />
<br />,,,,!,< ,a.P~LICAT]'ON NO: 9* 8,,979
<br />
<br />KATFi¥
<br />
<br /> $3.
<br /> ,.to ',>. ¢ ,3
<br />
<br />,TOTAE. ,.AS$?'~SED f:;~'~;.:, $56.3X
<br />P~,.V ~}Ot,,IS" REOET PIS ,t
<br />7'~ZS RECE~':~7 $58..3X
<br />
<br />BALANCE .,.3t.,t E
<br />
<br />...... "-' ~'" 3' ,',R,,,(.,~, I P r
<br />· ,,....,E. ¢,z j ..... -,y~E~, K CHECK ~ ,. d ,9
<br />:*, TH!S ~T,~ NOT A PEC;~4IT. 3'H,,,Z~{,,A~.'rOATIONdvJJ,!~T GO',THBOI, dGH ,,,A RE'VIEW PROCESS ~ERE THE
<br />FOLL~ING~ST BE ~PLE~ED:~<',,,;?'[~?,IS"'TH~ '~IBI~ITY OF:,~HE APPLICANT TO .&%~RE THAT
<br />ALL NECE~ARY !NFO~TI~' H~',~BE~ ~V'IDED~. ," j: ;?,j ,
<br />
<br />"....~' :<~Vf~¢~,. ~'/ ' D.-~..T%' 8N: 3Y CC~
<br />
<br /> · ,. ~ .>~ oEkV.,.¢ & ,.,,O -, 805
<br />
<br />fO[4M#M015-$8 REVll/8(~ OFFICE COPY
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