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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: 58B-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am performing work on a progorty I own or occupy <br />lamaregistetedbuilderORt ! he auhorizedrepresen <br />of a registered builder <br />The work will be performed by a registered builder <br />Other_ <br /> <br />I have read and agree to the terms stated on the reverse side of <br />this document <br /> <br />SI(~NATURE OF APPLICANT <br /> <br /> .,ROWO~N, WAL, L~rJ~ & J~N I <br /> <br />O~f~I f OR 9~342 <br /> <br />I PHONE: 954~3916 <br /> <br /> 13 ~ D2 rO <br />[WIDT~ )DEPTH ' ! A~EA : UNITS <br /> /U; !SI I 105/U. ~P <br /> <br />DATE <br /> <br />CON l RAC 1 OR, NO <br />C~DER, ~,ALL.ACE & JONN <br />~.~ 80X <br />DEIROZ f OR <br />P'r~ONg, 854-3'9 ~b <br /> <br />,~FdCH ! l '-C ! /bNG [NEb. F? <br /> <br />PLaN REV J ~ <br /> <br />AI'4OLINI <br /> $269 50 <br /> $175.18 <br /> $~3,48 <br /> <br /> 'i'D ~'AL A,E~E~ED <br /> THIS RECE.fP,.T"4 $0 00 <br /> <br /> R~CEiVED ~'f: DB 'FYD~ CHECK ~: 0 <br /> <br />FOLL~NG ~Sl ~E C4~PLEf'ED. ~ iS THE REdUCiBILITY OF THE &PPL1C:AN7 fO A~IRE fHA[ <br />ALL NECE.'$$ARY ~NFO~ZF~ HAS ~E~ <br /> <br />A>L~.N ~EVJE~: DY DATE <br /> <br />~ONiNG: BY OAt~ SETBACKS: <br /> <br />HEIGHT: 24 <br /> <br />CiTY JURISDiCYirST: DY DAlE <br /> <br />TOTAL-' <br /> <br />FR,20 LS 5_F¢',~ 5 RR 5 5P <br /> <br />FORM # MC ~-~6 nC_V ,~mo CUSTOMER COPY ,,,-¢ <br /> <br /> <br />