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SENATOR BLDG NO 225 <br />220 H[GH STREET NE <br />SALEM, OREGON 97301 <br /> <br /> PHONE:: 588-5147 8::00 - 4:80 <br />24 HOUR CODE-A-PHONE:: 588-7904 <br /> <br /> TIME: !2:29: !Et <br /> <br />HAl. LACE & JOHN <br /> <br /> i,/% iCAFI I I ¢~.fvl ,~'v'l~ <br />DE! ROI T OR Et/'342 <br /> <br /> ' ' ~ L¥ <br />MAll iNG AC)OH~S~ ~ZN(_~L_E F ,M: L'~ELLiNGS <br /> <br /> SIGNATLIRE OF APPLICANT <br /> DATE <br /> <br /> TAX LOT <br /> <br />TION TYRE <br /> <br />LOT <br /> <br />BLOCK <br /> <br /> 151 <br /> <br /> 02 10 <br />1 Ob "0_ ~- <br /> <br />9022 1'~SU <br /> NO <br /> <br />I"~AMMON D <br /> <br /> V~LU,'", I ~ ON. <br />RANGE <br /> <br />IRREG LOT <br /> NO <br /> <br />OCCUPANT LOAD <br /> <br /> 13524 <br /> <br />ZONE MAP <br /> <br />CORNCR <br /> YE::D <br /> <br />~Y~, bU[LL;'dNL'~ PER, if OR APPLfC,~fiON <br /> <br />CON~ RACIOR, NO. <br />r.;RO~CD~f.:, WALLACE &: JC)H~ <br /> <br />-~HONr: :: 854 '~39 1 6 <br /> <br />PLAN <br /> <br />,~RCN ! ~ ECl/EI'4GiNEE!,~, Al(}. <br /> <br />RHON ~,: <br /> <br />FOFAL. ~E'$SED PEES <br />PNE¥i OUS RECEi P'~ 5 <br />~HtS RECEiR f <br /> <br /> !HUb !5 NOT A P~RMIT, !Hi5 APPL,[CA/ION MUll GO THROUGH A Ri:VLEN PROCES~ WH~R~ <br />h(,)LLONiNG MUS[ 8E COMPLETED. if ~S f'Hg RES~NS!SiL~fY OF file APPLICANT '1'0 <br /> NbC~o~ARY iNPOR~4A'I ION HAS SEEN PROVIOED, <br /> <br />~ MC, ~-~,~ RE~ 4~o OFFICE COPY <br /> <br /> <br />