Laserfiche WebLink
MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM1 OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am a registered builder OR the authorized representative <br />of a registered builder, <br /> <br />this document, <br /> <br /> ~1;~)~ n);hb SE . .... ~ CONTRACT CITY: ~ UGB: ~OCCUPANT LOAD: <br />Dh "Fl~O ]:'f OR 97342 ~ETROZ'f' ~,J ~'.} <br /> <br /> I <br /> <br />DI:.Ct.:,I,,,[.~ F'],. :~::1,7 <br />VAN NUYS~ CA 914~6 SITE NUHBER: <br />PHONE~ 8'[8-91~0-'5211 ~ VALUATION= <br /> <br />17050 , qO [ ~0 <br /> <br />TYPE: PLUMRIN~ PERMIT OR APPLICATION <br />t, J F( k.flt 101~,,, NO. 84745 <br /> <br />be'h" o~ t~ <br /> <br />QUANT;[TY AM .I J ~ <br /> i S2'j .. ~¢0 <br /> $1 ,, ,r,~ 0 <br /> <br /> FOTAL ASSESSL"-:D FEES <br /> PRE:VIOUS RECEIPTS <br /> THTS RECEIPT <br /> <br /> BA[:ANCE DUE <br /> <br />PJ]LEi£VL;D BY: pP. ........................... ~ ..................................................... <br /> <br />TY."E. IN CHECK <br /> <br />* THIS IS NOT A PERfllT. THIS APPLICATION NUST GO THROUGH A REVIEW P~BCESS WHERE THE <br />FOLLOWIN~ NUST BE COMPLETED, IT~IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> LL NECESSARY INFORMATION HAS BEEN PROVIDED, <br /> <br />':>LAN F(EV.[EW: BY ..................... DATE <br />REM~,RJ((~: <br /> <br />.IfY JLIRloDICfION. BY ;()A~:,, ............ <br /> <br />FORM # MS 15.55 R~. 4/90 OFFICE COPY <br /> <br /> <br />