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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 />am per o m ng work on 8 property I owe or occupy. <br />t em a registered builder OR ( ) the authorized representative SIGNATURE OF AEEUCAN : · <br /> <br />The work will be performed by a registered builder. <br />Other <br />I have reed and agree to the terms stated on the reverse sido of [)ATE: <br />this document, <br /> <br /> ¢,L,,~ .... I,..I .... OR 97525 ~ARtON COUN'TY~ NO ! <br />0~E dr BOILD~N~: - ?NO 0¢ ~O~0OMS <br /> <br />: z~01 4T00~ : SF ,in i km <br /> <br />TYPE; MANUFACTURED STRUCTURE <br />COMTI"<ACTOR :~ N0,, <br />A ;,i D E: F< -.r'~ 0 I'l ,, ROOERTA <br />4490 S I L 7EF;t-:'Oi,I <br /> <br />PERMIT OR APPLICATION NO: 984641~ <br /> <br />MAil h A '/ Jd_L ,.~'¢,q, .... UR'.: Z 3~'L,.Nfoc'r r,""°"',,nAkG,_m ~ <br /> <br />QUAN'f' :['l"Y <br /> <br />i-AYI;,k,,. M;,d_L¥,, k,d._L],A~l r~,._[,L_i ~ f-86,,~7 <br />F~.E'.CE'.[VE.D Z~Y:', cl. 'I'YF'E~ CA CHECK ~: '~ <br /> <br />* THIS IS NOT A PER~IT. THIS APPLICATiO~ ~GST ~0 THROUGH A REVIEW PROCESS W~ERE THE <br />FQLLOWING H~ST BE COMPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE <br />THAT ALL NECESSARY INFORMATION HAS BEEN PROVIDED. <br /> <br />FOFIM # MO 15-5~ $~V, 4/~0 OF F[CE COPY <br /> <br /> <br />