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MARION COUNTY BUILDING iNSPECTION <br />SENATOR BLOC, 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-?904 <br /> <br /> I am a registered builder OR ( ) the authorized representative SIGNATURE OF APPLICANT: <br /> of a regiatered builder, <br /> <br /> Other <br /> I hove read and agree to the terms stated on the reverse side of DATE; <br /> <br /> 9{~84 ~-.'448 ', RESII)EN"¢ ]:AL <br />~i¥0~ '~Gb~E~: ,: CONSTRUCTION TYPE: [ 8bSU~NSYi : <br /> <br /> 72C~ ~D"H S'? ---. ' <br /> -. = ~.[...L: OR 97325 ~ Adh'SV;LLE <br /> <br /> :; susmw~o~: <br /> <br /> SITE NUMBER: <br /> <br />TYPE: ELECTP. ICAL <br /> <br />CONT:~¢['¥' R ,0 ~4z~'~' <br />1.. ;l%lii'.I'4 S Iii 1,!0 .;. ......... <br /> ~!R:(I,IK~ I-.;OHE S~CJR~TY <br />!215e 5. W (:;AI:U F', :' ACE' ,~'- <br /> <br />PHO1 iE;~ 684--'3~79 b <br /> <br />[.. I'4 :['f'ED <br />ELECTR]J;AL S?'A'rE SURCHARGE <br /> <br />PER,tIT OR APPLICATION NO: 4644~ <br /> <br /> ¢.~ I~- .... <br /> c L.- EkV.[Slh G E'LIF, CT!-~iC-iAI,I/NUM)3ER <br /> <br />CiUAN'r ITY A I .. ,.. ,~ <br /> <br /> TOTAL ASSFZS,SfED FF2FS ,.~ ~ <br /> · r. "c Rn .... ~;.. <br /> <br /> Pr YEE'~ <br /> ' ":'"u ..... ,, [~.:.~ I;; 1 f' lq[l= <br /> [ ~} [ ~2 ,, LD " ....... <br /> ................................................... :=;:;;;;::::::: .......................... 2,.,]...2. ................. TY h... CH[:.,.~X ~::: 47¢ 58'~ '~'-'~ <br />· r. zs ~s a wL~ ~z,, ,.zs ¢S~ZT [XPZ~[S ~Se ~aYS F~O~ ~*S ~'-'~;5~'2-"'-'~;~ ............................. <br />CONSTRUCTION CEASES FOR A PERIOB OF t88 ~AYS~ OR iF CONSTRUCTION' FAILS TO MEE~ ALL' <br />SHALLREQUIRE~ENTSBECOME NuLLOF STATEAwQ VQIB.LAWS AND MARION OOONTY BUILDING A~ ZONING OR~INA~ES~ THIS PERmiT <br /> <br />l)Of,I(~l...~.~ .... c' I¢['10)')1...;!:¥, ~l¢-;RIO;,i Ct']liNTY }t(/]:,'..l)IJ,l[; ,.,l":'r:T ...... ""At_. / <br /> <br />FOR~ # MC ~-Se.EV. 4~ OFFICE COPY <br /> <br /> <br />