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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 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am perfoCmir~9 work on a property I owr~ Or occupy. <br />I am a registered builder OR( ) the authorized rep~esen~aUve <br />of a registered builder, <br />The work will be performed by a registered builder. <br />Other <br />[ have read and agree to the terms stated on the reverse side of <br /> <br />owN~A'f'E: 06/04/90 TIME:8.26;49 <br /> <br />SITUS ADORESS:RF?~A' RCSER'i" <br /> <br />SIGNATURE OF APPUCAN'(: <br /> DATE: <br /> <br /> TAX LOT; <br /> <br /> SONSTRUCTION TYRE: <br /> <br />CATEGORY: <br /> <br />OCCUPANCY: <br /> <br /> 395 r'IAIN S'I' -- <br /> AUfvE~VILLE OR 97325 <br />USE OF BUlLDINa, Ad~ViEEE' NO <br /> <br />OCCUPANT L0~2 <br /> <br />: MAILING AODRESSI OF'[';;'.ICE, BANK, AND PROFES.~IONAL BUS~: <br /> <br /> P.O. BOX 617 <br /> STAY'rON, OR 9?389 <br /> PHON~; SITE NUf',II~ ER: <br /> LOT: SLOCK; SECTION: TOWNSHIP; RANG~/:ALUA'f' ION '~ ZONE: <br /> <br />10:~18 <br /> 500. <br /> <br />WIDTH: DEPTH: AREA: <br /> <br />'0NI+S: i~R~G LOT: <br /> <br />NO: NO <br /> <br /> TYPE: BUILDING PER~41'F OR APPLICATION NO: <br /> <br />CO¢4'I'RACI'OR, NO. 51352 <br />REA CONSr. INC. <br />P.©. BOX 6/? <br />S'FAYTON, OR 97383 <br />~E: 769~6566 <br /> <br /> I 'I'EM <br />BUiLDiNG <br /> <br />FL~E'f' ~HA~E -ZONE <br />BU JLBJNG STATE <br /> <br /> 9024561 <br />ARg,141'¥'EC'F/ENGINEER, NO. <br /> <br />PHONE~ <br /> <br />TOTAL ASS~Eo FEr-'~ <br />PREY l OU$ RECEIPTS <br />THIS RECEIPT <br /> <br />Q~JAN Ti I'Y <br /> <br />$25.00 <br /> <br /> ~3.84 <br /> 1+25 <br /> <br />$46.34 <br /> <br />$46.34 <br /> <br />$0.00 <br /> <br /> PAYEE: REA CONST. INC+ <br /> RECEIVEO BY: PB ~¢"~) 26010 <br />* 'm~s is NOT A PER~iF. 'tHis ARPLI'C.~I'iON I~ST C-~ 'rM~7~A R~¥1EN PR~'"'E~S ~HERE THE <br />FOLLOWING ¢4UST <br /> <br /> CiTY JURiSOlCI'I~: BY DATE <br /> SEPTIC: BY DATE <br /> <br /> Z~NG: BY DATE SETBACKS: FR ~S ~ RR SP <br /> <br /> HELGH'f': TOTAL ~ DT: DJ00 ~]'OR[B~: P "" <br /> <br />OFFICE COPY <br /> <br /> <br />