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MARION COUNTY BUILDING INSPECTION
<br />SENATOR BLDG. NO, 225
<br />220 HIGH STREET NE
<br /> SALEM, OREGON 97301
<br />
<br /> of a registered builder.
<br />
<br /> Other
<br />
<br /> l( f.., 04/(/EL/95
<br />OW~ER: !i1¢'"'",¢')"?:,, KEN
<br />
<br />51!13¢I S!-.fAI4 HWY
<br />
<br /> PHONE: 588-5147 8:00 - 4:30
<br />24 HOUR CODE-A-PHONE: 588-7904
<br />
<br />.... C6;~ST~UC¥10'N' T~PE] .......... !'b'0bu PANC~' '
<br />RF
<br />
<br />SITE NUf4BER:
<br />VALUATION:
<br />
<br />PERt~'T Ol~ A,PPL:fCATION NO~' 9846:~41
<br />
<br />TOTAL, f4,~SEoc~L~; FEEo
<br />F'~!EV![ L S RECE']'PTS
<br />Ti"d; S RECEIPT .....
<br />~.~: A ... A l"l [; E I)tJE
<br />
<br />(.!UANTtT¥
<br />
<br />'1 =.%,,
<br /> $0,00
<br />
<br />~,A/~:..l:.,, kb, N~E/I.,, D,, E!F,,N'FZ .... , ......
<br /> d:.l ;1,1 T 48560
<br />,-d:~,,.,.. ,,:,]; ] y., cl
<br />........................................................ :..==.==.,:.::,,::,,~,=,, .............. = ........ :.,,,,; ............ .:.:._._._. ...... '['¥F'E~ CK CHECK :ii:: J, 457
<br />~ THIS IS NOT A PERMIT. THIS APPLICATION ~UST ~O THROUGH A REVIEW PROCE~ WHERE ,THE
<br />FOLLOWIN~ ~QST BE COMPLETED. IT tS THE RESPONSIBILITY OF THE APPL~OANT TO ASSURE
<br />THAT ALL WECESOARY INFORMATION HAS BEEN PROVIDED,
<br />
<br />RS" ',;'G"'
<br />
<br />OFFICE COPY
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