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MARION COUNTY BUILDING INSPECTION
<br />SENATOR BLDG, NO. 225
<br />220 HIGH STREET NE
<br /> SALEM, OREGON 97301
<br />
<br />( )
<br />
<br /> PHONE: 588-5147 8:00 - 4:30
<br />24 HOUR CODE-A-PHONE: ,588-7904
<br />
<br /> DATE: '~),',!/;!6 / 9 S "i' [ MF:;~
<br />OWNER: TAX LOT; CATEGORY:
<br /> BAU(;HMAN,~ (;I,~ALP W 2276,.,,6:16(~-~ kt [~II
<br />S{TUS ADDRESS: CONSTRUCTION TYPE: OCCUPANCY:
<br />
<br /> 5"'N H'"'
<br /> :1~788 !~:[HPSON RD SE coNfAAof~rfY; UGB: :OOCUPANT LOAD:
<br /> AtJHSV:(I...LE: OR 97:~25 ' MARION COINrY
<br />
<br /> OTHI~. F~ NON-RI; S ~ DIHfT I AL. BU I L D I
<br />
<br />366:1. MAI;~YLAI,Ig PARK WAY -t)2:L
<br />I_AS \IIi:I;-A .~; ~
<br />PHONE: 78:1.-.2655
<br />
<br />S'tTE NUMBER:
<br />VAI,..UA'F Z ON:
<br />
<br />2ti, 8,'9 :l W I~,1:-' U
<br /> NO
<br />
<br />,,TYP£: ~IIILDIH[; PERMIT OR
<br />CON I'RAC. TOR~ NO,. 46986
<br /> COLIFMAI,] ]RROINE:I'~S I:ONST. CO.
<br />?.1440 SOIJTH HASKIN MILL ROAD
<br />I:,81..TCIN ~ 97017
<br />PHONE: '78t-265,5
<br />
<br />NO: 9i~4§559
<br />
<br /> A R C I'l :[ I'E I:.' "1' /E N (; [ I'i ~: t':: !'{ ,,
<br />
<br />F'I,~ 0 N E ,,,'
<br />
<br />I TEN QUAI,IT
<br />
<br />TOI'AL ASE:ES.~ED FEES
<br />PI;~E FIE}LIS RECE:ZF'T$
<br />TH :[ f.~ I~l;:[:l:_:tl:)'r
<br />
<br />BA_ANLE I)UE $~.. ~
<br />
<br /> F'AYE[::
<br /> RECEIVEI) BY: PH 'r'(P:,': 'l..1.,:ut'" -' ,ih:
<br />* THIS IS NOT A PERMIT. THIS APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE
<br />FOLLOWIN~ MUST BE COHPLETE~. IT IS THE RESPONSIBILITY OF TH~ APPLiCANt' TO AS~RE THAT
<br /> LL NECESSARY INFORMATION HAS BEEN P~OVIDED.
<br />
<br />PtAN I~[-'.VI[~W: BY_.. _.._~... ,~..___ bATE
<br />
<br />C:[1Y ,,llk,r,},,(,[]CIl,, BY DATE
<br />RE NAR(S~ ~I";'P FOR EXEHPT ST~TI.]S .... AC; ~U'ILD[NG
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<br />I~E:((;HT: SI::'I'BACI(S: F'R ./
<br />TOTAl_ SQ F'"f: 0 I..!.;
<br />,gTC, R :1: ES:
<br />PI,,,~N. Al. 11 ON ,, I ;~ I:;:" '"'::~'
<br /> [,Y
<br />
<br />OFFICE COPY
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