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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG NO 225 <br />220 H~GH 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 OF APP[,,ICANT <br /> <br />OAV], [YoON~ JORN <br /> <br />TAX LOt CATEGOR'Y <br />CONSTRUCTION TYPE, OCCUP,ANCY <br /> <br />RESIOENfIAL <br /> <br /> 12054 MESf 5rAYFON R0 <br />AUIVI~ViLLE OR <br /> <br />97325 <br /> <br />SE <br /> <br /> CONTRACT CITY ~ UGB OCCUPANt' LOAD <br /> <br />IVlARI ON COUN fY NO <br /> NO OF BEDROOMS <br /> <br />MAILING /d3 F) ¢~ESS .... SUS~IvISION 3 <br /> <br />PHONE: ?69-?449 <br /> <br />W~DTN DEPTll <br /> <br />11879 I¥CCLELLAN <br /> SlIE NUMBER: 120~3 <br /> VALUA]ION: <br /> <br /> 13 9S 2N ~FU <br /> 2. AC NO NO <br /> <br />fYPE: ~rOBtLE HOM~ PERM~ OR APPL~CAIJON NO: <br /> <br />CON [RAC'fOR, NO. <br />OAV ], O~r, ON, JOHN <br /> <br />PRItViARY L~bLL,~NG ,'~1 11679 IviCCLE <br />PHONE: 'f(59-744.9 <br /> <br />~OBIL~ HONE ~AS'B FEE <br />IVlOBIL~ HOi'4E 5TALE FeE <br />~O81LE HONE ZONING 5URCHAf;{GE <br /> <br />9029601 <br /> <br />tOtAL ~EO FEES <br /> <br />QUANIIIY <br /> <br />A,"flOUNf <br /> ~89.25 <br /> 15./5 <br /> ~5 25 <br /> 5~25 <br /> <br />$115_50 <br /> $0.00 <br />$~15.5~ <br /> <br />BALANCE DU£ $0.0O <br /> <br /> PAYEE: OAV1~.5ON, JOHN ~ RECgiPF 31268 <br /> R~CEIVED MY: PEt .~") TYPE: CK CHECK ~: 3108 <br /> <br />~OLL~ING ~ST BE ~PLETED. IT iS THE R~SIBIL[TY OF THE APPLi~T TO ~RE THAT <br />ALL NEC~ iNFO~TI~ H~ 8E~ P~I~EB. <br /> <br />~-ORM ~ ~C ~,-~,e ~IEV ,~90 OFFICE COPY <br /> <br /> <br />