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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: 558-7904 <br /> <br />I 8m per o r~ nB work on a property own or occupy. . <br />I am a registered builder OR ( ) the author zed represen ave SIGNATURE OF APPLICANT. <br /> <br />The work wild be performed by a reglstere¢ builder, <br />Other <br />~ have read and agree to the terms stated o~ the reverse side of <br /> <br /> '~--N <br /> 1.058.4 MILL Ct,.:EN RD SE <br /> AUH~;W]:L i,, I; OR 97325 <br /> <br /> CORNER; <br /> ~, , ~ NO NO <br /> <br />TYPE: BUILD[HG <br /> <br />CON'fRAC'f'OR.. l,lO ,, <br />M lfl,tCI"l .~ ,JAltES <br />SA~E <br /> <br />PI'.iO Nl:i:: <br /> <br />PERt'lIT OR APPLICATION NO: 467;~5 <br /> ARCH~'fECT/ENI; II,lEEk', NO. <br /> <br />PHONE." <br /> <br /> :[ 'f'EH £,~U AI4T I TY AHO[.IIT~ <br /> $17. <br />F L,,AN <br />BUll.DIN(; STATE: SURCHARGE <br /> <br />TOTAL <br />i,,~RE¥ ~,OUS ...... <br /> Rg'CE,[PTS <br />TH;lB RECEIPT <br /> <br />$29,, 76 <br /> $0.00 <br />$'.'.).9., 76 <br /> <br />BALANCE DUE $0.00 <br /> <br /> I:;'AYEE¢~ MUNCi-I~ JAH£S O , 48977 <br />...r-.!.~?.!! ~..v..?._..E ..!... ~.!:S,.~'~=_===,=-== _=:..==.==-_-.:::=: ................ '); .EE L...~i:%.~:z~!Ec~_!_'!t: _!! ............................. <br /> ~ THIS IS A VALID PER~IT. THIS PERMIT EXPIRES 188 DAYS EROM ITS ISSUE DATE. IF <br />CONSTRUCTION CEASES FOR: A PERIOD OF 188 I)AYS, OR IF CONSTR:UCTZOH FAILS TO HEET ALL <br /> EOU~EE}fEHTS OF STATE LABS AN]) NARION COUHTY BUIL])IHG AHI) ZONIH~ ORDINANCES~ THIS PERMIT <br /> ~ u~_2.--/.c:i,~ ~-~:~;,'r~ l~ s~'r~c~s:, ~.;'~ <br /> TOTAL SI] F'F= ¢ LS .......... <br /> <br /> ':' ~:' '~' PL,~N.~ETZOI'I;: RR .............. <br /> ENERGY r:'ATHI: SF'. .......... <br /> <br /> 'O[)I,!ALO i;~T.. %0(' ::"f~ N~R'I:ON C()UNTY Bt.~:/;t.O;~NG OFFt[t:IA)... / ~' . ................................................................................ <br /> <br />FORM # MC 15.56 REV. ~/90 OFFICE COPY <br /> <br /> <br />