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MARION {;(DUN I Y [¢UILDIN(5 IN~F~-U I IUN <br /> SENATOR BLDG NO 225 <br /> 220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE:: 588-$147 8;00 - 4:::30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am performmg work orl a property I own or occupy <br />I am a registered budder OR I the aufhonzed rep esen a ye <br />of a reoistered builder <br />The work w~ll bo performed by a regis e ed bu de <br />Other ,, <br />I I~ave road and agree to the terms stated on the reverse side of <br />this documen~ <br /> <br />S~GNATURE OF APPLICANT <br /> BATE <br /> <br />OWNER <br /> <br /> FISHER, MATTHEW <br /> <br /> 5'f'~'OC-GO0 <br />CONSTRUCTION TYPE <br /> <br /> 125 Sf-'A'UCF,,. I,:r <br /> AUIv~V ILL, g <br /> <br />USE OF B01LDiN~ <br /> <br /> ~ CONTRACT CITY <br />OR 9'~s,z~ <br /> <br />M~ILING ADDRESS ~iNGL~ P~,M[LY fD~ELL:[N~ <br /> <br />PO BOX 12'/36 <br />PORI LAND OR 9'7Z 12 <br />PHONE: 25'?--5901 <br /> <br />LOT BLOCK SECTION <br />23 <br /> <br />TOWNSHIP <br /> <br /> iCATEGORY <br /> <br /> ~ODCUPANCY <br /> <br /> .: R~3 <br /> ~ODCUP~NT LOAD <br /> <br />.... J /~d OF~F~O0~$ <br /> <br /> 3 <br /> <br /> 5i ] E NUI'CJCgR: * 3263 <br /> VALUA f ION :: <br /> <br />IRR~G LOT CORNER <br /> NO i No <br /> <br />MAP <br /> <br />C()N f RACIOR NO_ /'095 <br />VALUE MCTdI['_E Hr..~M~fi <br />1001't Sb_ 82NQ <br />PORILAND, OR -~r25b <br />c~HONE: ''7/"9/9/ <br /> <br />P~-~P¢I T ON> AF~PLICAFION NO: <br /> <br />NK)BiLE HOP4E ~TATE 5UN'%;HAR~E <br /> <br />P~YEE: <br /> <br />QUANtifY <br /> <br />FOIAL ~E~ED F'E~5 <br />PR~/iOUS RECEIPTS <br />THiS RECE]P) <br /> <br />~MOt. JN f <br /> <br />~1102b <br />mllO.2b <br /> <br />BALANCP~ DUE $0 0(~ <br /> <br />INVOICE <br /> <br /> R~CEIVE¢ HY: CL2 TYPE: CHECK ~: 0 <br /> <br />* THiS IS A VALID PER241T * THIS PEF~IT EXPiRE~ 180 OAY~,FR~ 1T$ iS.~JE DATE_ IF <br />CONSTRUCTION CEA~iDS ~OR A PERIOD OF 180 DAY~.OR IF CONSTRUCTION FAIL~ TO M~gT ALL <br />REQUIRE~IENTS OF STATE LA~ AND I~RION COUNTY BUILDING A~D ZONING ORDINANCES. THIS PER~iT <br />SHALL S~1C~E NULL AND VOID. <br /> <br />5BFBACKS: PR 1(~ L5 10 RS 10 RR 10 SP <br />RE~ARKS; ~)OB%Lg HQME PLAC~N~ ........ <br /> <br />PLANNING ACILON: <br />DONALD L WOODLEY, MARION COUN?Y DUI_DiNG' I ' ' OFFiCiAL / BY <br /> <br />FORM ~ MO 15-56 REV 4/90 OFFICE COPY <br /> <br /> <br />