|
MARION COUNTY BUILDING INSPECTION
<br />SENATOR BLDG. NO. 225
<br />220 HiGH STREET NE
<br /> SALEM, OREGON 97301
<br />
<br /> PHONE-: 5B8-51
<br /> 24 HOUR CODE-A-PHONE: 588-7904
<br />
<br />} am a registered builder OR { ) the authorizeO representative SiGNATUrE OF APPU
<br />of e registered builder,
<br />
<br />The work will be per(oemed by a registered builder.
<br />Other__
<br />
<br />! SITUS ASORESS;
<br />
<br />..... ,,.,,_ ~ ....... TAX hOT:
<br />
<br />........................ - - !~0 0F B~0R00MS
<br />
<br /> , S~TE NU~ER:
<br /> V~i_,U~T Z ON ~
<br /> RANGE; ~ ;CONE;
<br />
<br /> i
<br />
<br />.~,-,-~ ..... ~ F.., q ¢) ~,, :~ .............. , ......
<br />
<br />TYPE: MANUrACT~REI) STRUCTURE
<br />L':ONTRAC"('Ot'.L~ NO. F149r~?
<br /> K:[]...!:;~[)Y!:i MANUFACTURFi:~> liOM.': SALE
<br />
<br />PER~IT OR APPLIgATION NO: 90464~9
<br />
<br /> :',: T E M
<br />,v,' A i,t LJi;:' A C 'T' U R F; D STRL/CTLJI;'E
<br />~'5Ai,JIJF'AC'I'LJI:;~E~) STI'~UCTLq:::E STATE FEE
<br />
<br />H~NUFACTUF::Ef) f4TPUCTURE ZOl,I]:kig
<br />
<br />l.) A... r--.,:x:>l'_'aSl:,D ,,.r_'J:.S
<br />..... ',/,. ,. [_,: r~,SCf: .' ,.~
<br />TH'rS ,,0~. _, =: '. ]:: T
<br />
<br />~A[..AN.CS DUE $0.08
<br />
<br /> Af .......... fi ,L,E,I,,,h ,, ,.iAI ,,., J- ~ F* L(.,[:. }. P 1 ~86,:~
<br />~':'", ' r~'. F' ~.,~ .'.~_ ,,~'., ~' -- ,
<br />,~),,,{.~...[. IL.I~ ~ .... ~ .......................................................................... r~ ......... -¢~ I.,IJEOls -]~,:
<br />
<br />FOLLOWING MUST BE COMPLETED. IT tS THE RESPONSIBILITY Q:F THE APPLICANT TO
<br />THAT ALL NECESSARY INFORMATIO~ HAS BEEN
<br />
<br />PI. Ail REV]El,F: ,~.Y ~ I),-6, TC".'. "::"
<br />ZOhI:(I Fir, I~Y M~_ "~ .............. ~)~'I'E''~'Z'~':~'~'' 7
<br />,',,".' v ............... '"
<br />..... ~ .... ..~:~F~ ..................... r,~,"~ '
<br />CITY , I i:?'[S~X[(7'F:[( ' ~Y g,~T~ Sr. .........
<br />
<br />
<br />
|