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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-?904 <br /> <br />I am a r?~istered bui~er OR the authorized representative SIGNATURE OF APPMCANT; <br /> <br />S['f US ADDRESS~ <br /> <br />14 9) 7 ~t / .... ~ b <br /> <br />CONSTRUCTION TYPE' <br /> <br />CONTRACT CITY UGB <br /> <br />CATEGORY: <br /> <br />...... ~!f_fN,",,~?' 't'~0'ErZ EE '?ARK ................. <br /> SITE NU~E~: <br /> <br /> RANGE: ~ ZONE MAp: <br /> <br /> fi~. ECT; ....... Cb~'(~ ...... ~j <br /> ....... N(; .................. ~¢'~ ................................ <br /> <br />TYPE: ~ECHANICAL <br /> <br />DtJ"f"]'0 '. / ~ ? AS <br /> <br />F'HL)i%I~ ~ ;cE "-; 2;';q~ <br /> <br />PERNIT OR APPLICATION <br /> <br />hE:r::HA!,I:!:CAL, ]}ASE F'E]~. <br />NECHAN][CA1.., STATE: SURC'dARG]i~ <br /> <br />~)Ai-A;4rH:' ])tie <br /> <br />[;~[JAI,i'I':I:'I'Y ANOiJl,i'f' <br /> <br /> lS IS A V~LZD PERHZT $ THIS PE~NIT EXPIRES 18~ D~YS F~O~ ~TS ZSSUE D~T~""-'~ ................................. <br />$~RE~ENTS ,DF STATE LAWS ANQ MARION COUNTY B!~ILDIN~ AN~ ZONinG OR~INA~CES~ THIS 'PER~IT <br />ALL BECOME NULL AN~ VOl~. <br /> <br />F,:E'K'A]:;:KS!:,,, ,~, ,, ki00DBT,r)'~/E <br /> ' '"' '" ,:~r- ," ,,, (,,.[A ,.. I. ............. <br /> <br />FORM # MC 15-~ RF~,/, Cf, lO OFFICE COPY <br /> <br /> <br />