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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 />SIGNATURE O¢ APPLICANT <br /> DATE <br /> <br />11/25/91 fiVE: 11;31:00 <br /> <br />CHURCH OF GOD OF PROPHECY <br /> <br />TAX LOT : CATEGORY <br /> 61221-000 <br /> <br />RESiDEN~i~!. <br /> <br />1063Y SIAYION RD S~ ~ CONTMACT OIT~ ' UGB OCCUPANT LOAD <br />AUMSVi LLE OR 973~5 <br /> f4ARiON COUNTY I NO ~ <br />UBE OF BUILDING N0 01- 8EOR00M$ <br /> <br />MB*LING ADDRESS MANUFACTURED STRUCFURE <br /> <br />SUBDIVISION <br /> <br /> 918 N BIRCH C/O 0~NNi50LSON <br /> S~AY[ON, OR. 97883 <br /> RHONE: /69-5088 SiTE NUfCt3ER~ 2302 <br /> VALUATION: <br />LOT !BLOCK iBECTION 'TOWNSHIP MANGE ZONE MAP <br /> <br /> 17 95 lW ~f. LI 60 <br />WIDTH DE~H AREA UNITS ' IMBEG LOT CORNER <br /> <br /> 2+ AC NO NO <br /> <br />~YP~;: MANLIPACTURED 5TRUCIURE PERMIT OR APPLICATION NO: 908?009 <br /> <br />CONfRAC/OR~ NO. <br />CHURCH OP GOU OF PROPHECY <br />9~8 N BIRCH C/O OENNiS OL~ <br />SIAYTON¢ (,)R, 9¢383 <br />PHONE: '/89--5088 <br /> <br />MANUFACFURED S~RUCYURE PLACEMENT/CONNgCTiON <br />MANUFACTURED SYRUC~LIRE S~A]~ FEE <br />MANUFACTURED SrRUC~UR~ S~AT'E 5URf,.."HAR~E <br />MANUFAC]URED 51RUC]URE ZONING SURCHARGE <br /> <br />PAYEE: CHURCH OF GOD OF PROPHECY <br /> <br />[OFAL A~,~ES.SED FEES <br />PREVIOUS RECE[PiS <br />THIS RECEIPf <br /> <br />QUANIi~Y <br /> <br />AmOUN~ <br /> $182,,0(~ <br /> $20_00 <br /> <br /> $~6,o0 <br /> <br />$225,10 <br /> $o.oo <br />$225,1o <br /> <br />BALANCE DUE $0,00 <br /> <br />REC8iYED BY: CL ................................................... fYPE: CK CHECK ~: 10'77 <br /> <br /> THiS IS NOT A PERMIT. THiS APPLICATION ~T ~ THROU(~ A RE~/IE~ PROCESS ~ERE THE <br />~PLETED. IT IS THE ~SI8,ILITY OF THE APPLI~T TO--RE THAT ALL N~ INFO.TI( <br />P~IOEO. ~ <br /> <br />CiIY JURISDiCYiON: BY BAlE <br /> <br /> ~ OFFICE COPY <br />;ORM # MC 15-5~ A~V 4/90 <br /> <br /> <br />