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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:: 888-8147' 8::00- 4::30 <br />24 HOUR CODE-A-PHONE:: 588-7904 <br /> <br />SIGNATURE OF APPLICANT <br /> DATE <br /> <br />owr~E= o3/1 ~/91 <br /> <br /> GRE~, JO~- <br />SITUS ADDRESS <br /> <br />TAX LOT <br />CONSTRUCTION TYPE <br />CONTRACT CITY UGB <br />I~ARI ON CO..IN TY NO <br />SUBDI¥1SION <br /> <br />11695 <br /> <br />LARK COURT NE <br /> <br />OR g7002 <br /> <br />MA~t~NG ADDHbSS MO~iLE HOME <br /> <br />CATEGORY <br /> <br /> RES I DEN f Z AE <br />OCCUPANCY <br /> <br />OCOUPANT L ~D~ <br /> NO 0¢ <br /> <br />CENTURY MEAI~.~ :~ <br /> <br /> PHONE: SITE NUt4BER .* 12433 <br />Z. OT Bt, OCK SECTION TOWNSHIP RAr~VG~LUAT ION: ZONE <br /> <br />IRf~EG LOT CORNER <br /> NO NO <br /> <br />MAP <br /> <br />ryp£: IVY,;81LE HOME PERMIT OR APPLiCAIrION NO: <br /> <br />CONIRAC'IOR, NO. 71471 <br />r(:~N ~ OOUNr~ EXCAVAtiON <br /> <br />~OODBURN, OR 97071 <br />PHONE: 98;'-1702 <br /> <br /> 11' E~ <br />MOBILE HO~E BA~E FEE <br />rCf,~iLE HOME SIA1E FEE <br />~ILE HOME ZONING <br />fQOBILE HOME S1'ATE ~LIRCHARGE <br /> <br />30725 <br /> <br />TOTAL ~%~E~EO FEES <br />PRE¥1OU$ RECEIPTS <br />THIS RECEIPT <br /> <br />¢,~JANIlTY <br /> <br />$15.75 <br />~5.25 <br />5.25 <br /> <br />$115,50 <br />$115.5o <br />$o.oo <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE: RECEIPr <br />RECEIVED BY: c'l TYPE: CHECK ~: 0 <br /> <br />~ TH18 18 A VALID PERMIT * THiS PER~IT EXPIRE~ 180 DAY~ FROM IT8 ISE~JE DATE. iF <br />~ETRUCTION CEASE~ FOR A P~IOD OF 180 ~,OR IF ~T~CTI~ FAi~ TO M~T ALL <br /> <br />~ALL 8~ ~LL ~B ~XD. <br /> <br />~EfBACKS: PR 10 L~ 3 Rf5 12 <br />REMARK,S= D'~OE~LE HOME R~5982 <br /> <br />PLANNING ACTION: <br />DONALD E. ~OODLEY, IViARiCXN COUNIY BUILDING OFFICIAL / BY <br /> <br />RR t0 8P <br /> C,ARFCDRT NOT""'INCUDED iN lHiS PERMI'F <br /> <br />OFFICE COPY <br /> <br /> <br />