Laserfiche WebLink
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 />J am per cfm ng wok ot~ a property I owrl or occupy. . <br />I am a registered builder OR ( } the authorized representahve SIGNATURE OF APPLICA <br />Of a registered builder, <br />The work will be performed by a registered builder, <br />Other ,,, <br />I have read and agree to the terms stated orl the reverse side of GATE: <br />this document. <br /> <br /> 5~ V'.[I.-L~E ~'~E~ {~OUF(T ~E ~ CONTRACT CITY: ~ UGB'. ~0 ANT LOA~, <br /> <br />USE OF BUILDING; N~'. <br /> HANUEACTUREI) STRUCTUF(E J'~ . <br /> <br />LOT: <br /> I. ;~ <br />,WIGTH~ DEPTH: <br /> <br /> " t~ Vil LACE <br />F'O BOX 642 . e~ ~ , t ~ Z <br />AUHEiV]:LLE' 0~ 97~25 ~~ SITE NUMBER: <br /> <br /> =: AC , IqO ~ lqO <br /> <br />TYPE-' I'tANUFACTURE]) STRUCTURE <br />CONTRAC'[OR.~ <br /> '.~. NTERC I TY S AI...I;;.,.~ <br />5o~..~,~ DE I-IWY %4 <br />ALBANY,~ ~7~:~:k <br />F"'H OI.IE 926--8c~44 <br /> <br />PER~IT fiR APPLICATION NO: 9846861 <br /> <br /> :[ 'l'EJq <br />dANLJI=AI;Tru~IE';[) STRUCTURE' PL_ACEi'~ENT/CONNECT;ION <br />MANOFACTUREI) STRUCTUI;iE STATE FEE <br />HANUF'AC'fUf~EI) STRUCTURE STATE SURCHARGE <br />HANUFAC'fURE~ STRUCTUF<E ZONING SURt;HARgE <br /> <br />TOTAL ASSESSli~.'I) FEES <br />F'R f-:.V I 0 LIt'; Ir~F-':~E I P TS <br />THIS RECE:i:F'i' <br /> <br />{l,I I_i A Iq T 1[ T Y A d {:) 0 ht 'l' <br /> $ e,, I, 0 <br /> $22¢,, <br /> <br />~AI...AI,iCE DUI:_": ~PO ,, g.,O <br /> <br />F'AYEE= [,TERC[TY~LiS~LES t3 RECE?T 4S2~5 <br /> ................... ............... <br />* THIS ES NOT A PERH!T. THIS APPLICATION ~UST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST BE CO~PLETE~. IT ES THE RESPONSIBILITY OF THE APPLICANT TO ASSURE <br />THAT ALL NECESSARY !NFORHATIOfl HAS BEEN PROVIBEB. <br /> <br />FORM # MC t5-58 REV, 4/~ <br /> <br /> <br />