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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG NO 225 <br />220 HIGH STRE6T NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE:: 588-5147 8::00 - 4::30 <br />24. HOUR CODE-A-PHONE:: 588-7904 <br /> <br />Other <br /> <br />SIGNATURE OF APPLICANT <br /> DATb <br /> <br />Rb~I DgN I 1AL <br /> <br /> 235 ~VERGREF. iN ,OR <br />,AU ~,:,V ,,I L L E <br /> <br />CONTRACT CITY <br /> <br />AUMSVJ~ LLE <br /> <br />NO <br /> <br />OCCUPAN~ LOAD <br /> <br />SUBDIVISION <br /> <br />P.O. 8OX 157 <br />AUIViSViLLE, OR 9'7325 <br />PHrJNE,: 74g- t52'! <br /> <br />LOT BLOCK SECTION TOWNSHIP <br /> <br /> EVLRGRELN ~)BIL~ ~STAIE <br /> <br />5ITE NU~ER: '119~8 <br />n~LUAFION:~. ZON~ M*P <br /> <br />UNITS <br /> <br />SF <br /> <br />IRFfEG LOT CORNER <br /> NO NO <br /> <br />(YPE: ~r,J~ILE HO~E <br /> <br />,CON [ FI~.C f OR, NO. 38238 <br />SANt ~,A(~ I'~lLe,,- Hr.~E5 <br />11373 ivI,~LL,CREEK RD <br />AUC45VILLE OR 9?325 <br /> <br />PEP, MI'~ OR APP~iCACION NO: 9029278 <br /> <br />tvF,)8iLE HOMB 51A~E FBB <br />FLEEr SURCHARGE -ZONE 3 <br /> <br />PAYEE: SANf~AM ~OB~LE HO~ES <br /> <br />~OIAL A~SS~O PE~ <br />PREVIOUS RgCEiPf~ <br />'f'HI~ RECEIPT <br /> <br />QUANrliY <br /> <br />AIV'F,)LJNI <br /> <br /> $15,75 <br /> $3-84 <br /> <br />$114,0§ <br /> $o. ou <br />$114,~g <br /> <br />F'3AL,ANCE DUE $0.0O <br /> <br />iNVOICE 30935 <br /> <br /> RECEIV~-I.) BY: ,oH ........................................... I"YPE: iN CHECK ~: <br /> <br />~ rH~ ~s NOI A PE~IT. THiS APPLI~rI~ ~Sf' ~ TH~ A RSVIE~ P~E~ ~ERE f'Hg <br />FOLL~iNG ~Sf BE ~PL~1'~D. iT I5 THE R~SiSiLifY OF THE APPLICANT lO ~URE THAT <br />ALL NEC~A~ iNFO~FI~ H~ BE~ P~iOED+ <br /> <br /> PLAN <br /> REVIEW: <br /> <br /> 5~P~'IC~ BY OA~E ClfY JURiSOiCilC~; ~V ....... <br /> <br /> RE~ARKb: ~O8ILE H0~ PLAOE~SN~ <br /> <br />CLANNJNG AC![ONt <br /> <br />OFFICECOPY <br /> <br /> <br />