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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: 588-7904 <br /> <br />of a registered builder, <br /> <br />MAILING ADDRESS: SDBDIVISION: <br /> <br /> PH(]NE~ 749-2794 r SITE <br /> VAL(J~T:I;ON: <br /> <br />TYPE: I)WELLIN[; PERNIT OR APPLICATION NO: <br /> <br />CO;qTRAC'fT,)IrL !,iO,~ 6:!.474 <br /> Lsr'r;:' F' I<qm'xi, q Il'lc <br />5496 72nd Ave SJE <br /> <br />DWEI,,,L:[ N(; <br />DWELLZFK; I~ECHAN:}:CA!, <br />~)WEI..L i N6 <br />DWELt...:I:Ng STA'¢E SUF?CHA;:;X;E <br /> <br />904642§ i)P <br /> <br />I .]. ~ El, T/'Eb ~ ...... ~ <br /> <br />F'H,.q_ NE: <br /> <br />F I .,...V ..,.).. RECEIPTS <br />7 "i~,.,~ R~:'CIii: i PT <br /> <br />BALAi,ff.;E DUE <br /> <br />(. UAN i .,. IY <br /> <br />~ THZS IS NOT a PERmiT. THIS APPLiCATiON ~UST 60 THROUGH A REVIEW PR~CEBS'~ ~HE~E THE <br />FOLLOWING HUST BE COMPLETE~. tT IS THE RESPONSIbiLITY OF THE APPLICANT TO A~SGR~' ~ ~' ~ THAT <br /> LL NECESSARY ZNFORMATION HAS BEEN <br /> <br />Z0N I I,;(;.: BY U""'"' ' ................ DATE ............................ <br /> <br />C :['T'Y l .... ) ..... BY ....................... J~)ATE <br />~?EY;Ai~:KS~'. DI411?L '~' ' ................................ <br /> <br />FORM # MO 15-56 ~EV, 4/gO OFFICE COFY <br /> <br /> <br />