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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 />of a registered builder, <br />The work will be serformed by a reglstered builder. <br />Other <br /> <br />I have read and agree to the terms stated on the reverse side of <br />this document <br /> SAN'T' 1AM H0f4E~5 <br /> <br />SIGNATURE OF APFrLICANT: <br /> <br />5??06-000 <br /> <br />RESIDEN'IJAL <br /> <br />OWNER: TAX LOT: CATEGORY: <br /> DA'T'E} 10/14/~1 D~IME: 15:46:07 5-N <br /> <br />S~TU 2~{l EWERGREEN i O0N~TRUCTION TYPE: OCCUPANCY: <br />~' ~Of~i~LE OR 9?326 <br /> AUlvISVILLE NO <br /> <br /> !' ~51',]YRAO~ C. 1~"¢'. ' UGB~ iOGCUPANT LOAD: <br /> <br />RESIDENTIAL ACCIg~RY STRUCTURES; ~ .... <br /> : NO 0F 8Ee~00MS <br /> EVE~REEN MOBILE H~E PARK <br /> <br /> SUBDIVISION; <br /> <br /> Si'['~ NU~ER: ] 2757 <br /> VALUAT t~ = $~; 120.00 <br /> <br />USE OF BUIL01NG: <br />MAILING ADDRESS: <br /> <br /> 4 25 8S 2W Rr4 <br />LOT: 55 BLOCK: 90 :SECTION: TOWNSHIP: ~F RANGE: YE~ ZONE: NO :MAP: <br /> <br />WIOTH: ;DEPTH: AREA: ~ UNITS: <br /> TYPE: BUiLDiNG PE~I'I' OR APPLi~'fI~ ~O; 9036090 <br /> <br /> ~TI~ H~ES <br /> <br />PHONE: <br /> <br />PHONEz <br /> <br /> l'rE,~,l <br />BUILDING FEE <br />PlJ~ RE¥1EW <br />BUILDING STATE SURCHARGE <br /> <br />PAYEE; SANriAr.I HOfl'IE~ <br />RECEIVED BY: <br /> <br />TOTAL AE~EBFEES <br />PREWIOUBRECEIPT8 <br />:THIS RECEIPT <br /> <br />BALANCE r.~JE <br /> <br />Q~AN'T'ITY <br /> <br /> A~qOUNI' <br /> $44.50 <br /> $28.93 <br /> $2.23 <br /> <br /> $75_88 <br /> $o.0o <br /> $?5.66 <br /> <br /> $o.oo <br /> <br />38016 <br /> <br /> :TYPE: iN CHECK ~: 0 <br /> <br /> * THiS iS NOI' A PER~I'r. I'BiSA~PLICAI'iON .L.~I~....ST.64,O THROUGH A REVIEW PROCE$.S WHERE THE <br />FOLL~ING ~'r BE R~SiBILI'FY OF THE APPLI~'F 70 ~RE 'IHA'f <br />ALL NECE~ARY INFO~I'i~ H~ BE~:P~ViDED. <br /> <br /> CITY JURISDICTION: BY <br /> <br />SEPTIC: BY BATE <br /> <br />ZONING: BY DATE .................................... SETBACKS: FR 10 DS 10 RS 10 RR 10 SP <br />REIvlARKS; CARPORT .............. <br /> <br />HEIGHT: 11 TOTAL SO F'I': 312 STORIES: 1 PLAN.ACTiON: <br /> <br />DATE <br /> <br />FORM # MC ~5-56 REV. 4/90 OFFICE COPY <br /> <br /> <br />