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MARION COUNTY BUILDING INSPECTION
<br />SENATOR BLDG. NO. 225
<br />220 HiGH STREET NE
<br /> SALEM, ORFGON 97301
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<br /> PHONE: 588-5147 8:00 ~ 4:30
<br /> 24 HOUR CODE-A-PHONE: 588-7904
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<br />I am performln9 work on 8 property I own or occupy. N~
<br />I am a registered builder OR the ~uthor zed rep esen ave SIGNATURE OF APPLICA~_~_~ ' ~. .~
<br />of a registered builder. '
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<br />'0SE OF BUlLheadS' ..........................
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<br /> TAX LOT
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<br /> CONSTRUCTION TYPE
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<br />............................
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<br />....... o~u/,X~b¥:' .....
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<br />VAt_LJA T t OM:
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<br />WfDTH'. DEPTH; AREA'. ................ u'NITs: ' ' ~-I~.'-~f .......
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<br /> · C(];q'TR~ZT[)R.~ NO,, (~-"';?154 SUPERV :S]Jt,t[;- : -"" ~ .......
<br /> ..... EL,~,,,_ ~ ~..C~A ,/,~ J~,,.:
<br /> i, ZCEMSE' ~ ~.,., ·
<br />
<br /> ~764 M;~],] Creel, f ;,
<br /> PHOME',; '7~?-'-297]. '
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<br /> · .ER ZC ,/~ ::P ,, I._L¢,.~ ~.,A I .~d~8 AMPS
<br /> PUMP OR
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<br /> ~7,,
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<br />TOWNSHIP; I~ANGE ,¥~'~"; ~X~; .......... ;
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<br /> D~LANCE ~t. JlE
<br /> ?A¢,:.b. ..... Jo,'m ~ opeer , .....
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<br />uu~.~uu~uN EE~SES FOR ~ PERIOD OF 1Se ~YS~BUiLDiNGOR IF CONSTRU~,~ON FA LS TO MEE~ ~LL
<br />REQUIREMENTS OF STATE
<br />SHALL BECOME NULL AN~ VOI~,
<br /> PERMIT
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<br />it;: EM AR K S ::
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<br />)} 0 i'iA !,,, D E ,.
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<br />:L MI'_:?¥']:~:R "(';.~:/:,('>,':&VZ',F' & :L PUMP
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<br /> ktf)(J)DL_!i!Y~ f,,..,~,Zf., COUi,ITY ~[.I]:L.D'I'I'J(]; OFt .,.f,,,,,At_. / BY
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<br />PO.M ~ ac ~s.s~ R~v, 4~ OFF[CE COPY
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