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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 />I am performing work on a property I own or ocqupy, <br />lameregisfered builder OR( ) the authorized representative <br />of a registered builder, <br />The work will be performed by a registerer builder. <br />Other <br /> <br />OWN.'~.'i" E: 10/14/93 T i'NEi <br /> <br /> SAN'I ~Ar4 HO~E~ <br /> <br />15:45f5'2 <br /> <br />TAX LOT <br /> <br />CONSTRUCT ON TYPE <br /> <br />b?T06-O00 <br /> <br />CATEGORY: <br />OCCUPANCY <br /> <br /> 240 EVERGREEN DR <br />AUNS¥ i LLE OR 9'i'325 <br /> <br /> CONTRACT CITY: <br /> <br />AUFCSVI%EE <br /> <br />UG8 <br /> <br />OCCUPANT <br /> <br />~,~,~u~a ~OOR~SS iVlANUFACTURED STRUCTURE <br /> <br />EVERGREEN IWOE t'LE HONE <br /> <br />PHONE: <br /> <br /> 55 90 ~F <br /> <br /> SI'rE NUIVl~ ER: 12Y5'! <br />! ~ar~/EALIJA'I: ION:'' ZON~ <br /> <br />RRSG. LOT 2{&f 'CORNER: <br /> <br /> YE,~- NO <br /> <br />MAP <br /> <br />fYPE: t',IANUFAC'FURED .STRUCTURE <br /> <br />CONFRACTOR, NO. 38238 <br />D~nte'l L C, ar*ver <br />'113'/3 Mfi I "l c~'~k Rd <br />au~vl I le, 9?325-0000 <br />F~'I~E: ?69¢??44 <br /> <br />PERNi'F OR APPLICATION NO: 9036088 <br /> <br /> l'f'EivI <br />IVlANUFACTUREO $'rFCdCTURE PLACEt4PJAI'[/OONNECTiON <br />1"4ANUFACTURED STRUCTURE STATE FEE <br />f4ANUPAC'TUREO STRUCTURE STATE .~JRCHARGE <br /> <br />QUANT I T Y <br /> <br />AIvlOUN [' <br /> $182.00 <br /> $20.00 <br /> <br />TOTAL A,%~E,SSED FEES <br />PREVICOS RECEIPTS <br />'rHiS RECEIPT <br /> <br />$211.10 <br /> $o.oo <br />$211,10 <br /> <br />8AL. AC4CE CUE $0.00 <br /> <br />PAYEE: ~%~,lTiAIVl HOCfl~ iNVOICE 38015 <br />RECEIVED BY: PS TYPE: iN CHECK 15: 0 <br /> .... ,...,,. ,,., ................................................ ,%,,- .....~ .~ ,.. i., -, ,,,-,ff. ~ .... .... ~ .... <br />:~ THIS IS NOT A PEI~,IlT+ REVIE~ PROCEE~ ~rtERE THE FOL. LO~NIN~ <br />COIqPLETED. it IS THE REE~OONSt8:t:LiTY OF THE APPLICANT TO ASSURE THAT ALL NECE~:iARY iNFORt~A}~I( <br />P~I OEO + <br /> <br /> CITY JURiSOiC'FION: BY .............................. DATE <br />P'R 10 L$ 10 R~....10 RR,,fl0 SP .................. <br /> <br />FORU ~ mc ~s-s~ R~v. ,~o OFFICE COPY <br /> <br /> <br />