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N COUN~i'Y BUILDING INSPECTION <br />SENATORBLDG 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 />[ ~m performir~9 work on a property I own or occupy <br /> <br />SIGNATURE OF APPLICANT <br /> DATE <br /> <br />BEACH, MbRREL <br /> <br />TAX LOT <br /> <br />CONSTRUCTION TYPE <br /> <br /> 8613 WEST SIAYfON RD <br />AU~'~,VILL~ OR <br /> <br />9?325 <br /> <br />CONTRACT CITY <br /> <br />MARION COUN fY <br /> <br />UGB <br /> <br />NO <br /> <br />RESJ ObN I <br /> <br />LOT <br /> <br />8 J: LL HALL [BURTON-REM IOR <br />PHONE: 749-1112 <br /> <br /> BLOCK <br /> <br />1. <br /> <br />AC <br /> <br />SITE NUFCB~R: 10166 <br />VALUAFION: <br />AAN~E ZONE <br /> <br /> NO NO <br /> <br />MAP <br /> <br />TYPE: MOBILE HOi'4~ PERM~'I OR APPLiCAI~0N NO: <br /> <br />r.,.,'ONTRACIOR. NO. <br />BEACH, MgRRgL <br />BILL RALLi~URION--RENIOR <br /> <br />PHONE: 749-1112 <br /> <br />HONIE AOO~L_ t.~URCHARGES <br /> <br />HOME SFORA~E <br /> <br />24032 <br /> <br />TOTAL A;.%~x,SED FEE5 <br />PRE~iO0$ RECEIPTS <br />THIS RECEIPT <br /> <br />¢~¢40UNT <br /> <br /> .84 <br /> $25.00 <br /> <br />$0,90 <br /> <br />BALANCE DUE $0.00 <br /> <br /> RECEIVED ~5Y: ~'~ ................................................... 'TYPE: <br /> <br /> ~ THIS 15 A VALID P~IT ~ ~IS PE~IT ~PZR~ 180 ~ F~ <br />~ST~C~ C~ ~R A ~ZOO O~ 180 ~,OR iF ~T~CT/~ FAI~ TO R~gT ALL <br />~IR~TS OF STATE ~ ~O ~RI~ ~ BUI~I~ ~D Z~ING ORDiN~C~, THI~ PE~ <br />~ALL B~E NULL ~ ~I~. <br /> <br />FORM # MC t ~-56 REV 4/90 <br /> <br />OFFICE COPY <br /> <br /> <br />