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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 225 <br />220 HIGH STR~:ET NE <br /> SALEM, 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 he au hot zed rep esen ave <br />of a registered builder, <br />The work will be peHormed by a registered builder, <br /> <br /> tion of ~he ~ystem, Contact the cty <br />~{GNATURE OF APPLICA~tOr [9~ begi,n~ln~ c.onstrpctlon, <br /> <br />~ AUHSV]'Li. E 0R 97'525 A[.~SV);LLE <br /> N, L],. CR'EJ~K E~ST~TE;S <br /> <br />FI'& E <br /> <br />TYPE: BUILDTN.6 <br /> <br /> i1 EH <br />/,;dl 1" L D :~ M (; FEI::; <br />i'fl hi'i <br />BU£1..O.I;N(', SI'ATE SURCH,~RF~E <br /> <br />8r {,d], 1E,(, l/E. NG Zl IEJ:R.~ <br /> <br />F H ,)NE. <br /> <br />PREg~[OUS.~RE( EIPTS <br />,TKI S' RECF'r P'f <br /> <br />CALANCE DUE <br /> <br />QUAN'T'ITY <br /> <br />AMOUNT <br /> <br /> $28.93 <br /> $2.2;~ <br /> <br />$ 7 5 ,. 6 4; <br />$7,"% 66 <br /> <br /> L ~EC0~E NULL AND vuzu,'~' ,' , ,, ', :, , ,' , '..' ~,, <br /> <br /> , , H; ..... ~- - ' " F R <br />..[~ .. t Y f:';~ fi'J',: , S'FO :~ZEE: ~ RS '6 ' <br /> PLA, ,, ACTIO 4: RR "' 1 E; <br /> ENERGY F'ATH: <br /> <br /> OFFICE COPY <br />FORM # MO 16-58 REV. 4/~0 <br /> <br /> <br />