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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::3,0 <br />24 HOUR CODE-A-PHONE:: 588-7904 <br /> <br />SIGNATURE OF APPLICANT <br /> DATE <br /> <br />FORBY, GEORGE <br /> <br />9:53:50 <br /> <br /> TAX LOT <br /> <br /> CONSTRUCTION TYPE <br /> <br /> 245 EVERGREEN DR -- 14 CONTRACT CITY UG8 <br />AUIVI,~,V i LLE 0R 97'325 <br />uss OF SUtLS~NG AUIV~Vi LLE NO <br /> <br /> RESI DEN ItAL <br />R-3 <br /> <br />MAll ~NG ADL)HESS ~¢IO~J. IE HO~ SUBDIVISION <br /> <br /> BOX 63(5 <br />AUFI~V,~ LL.b., Of'< 9'7325 <br />PH©NI(; s 749-2792 <br /> <br />Sire NUMBER: <br /> VALUA f iON .* <br /> <br />MAP <br /> <br />56 1 14 62?0. SP NO NO <br /> <br />fYPE: ~L,E HOM~' PERFI,[ f' OR APPLICA[iON NO; 9032434 <br /> <br />CON iRACIOR, NO. 14922 <br />C-ENIRAL ORhGON <br />285 SO-P$~iPiC HiGH~AY <br />WOOD'BURN, OR~GON 9V07] <br />PRONg: 98t-314~ <br /> <br />MOSIL~ HOME 8A~b. <br /> <br />~'f. YSiLE HOr~E $~ArE <br /> <br />101AL ~E~ED FEES <br />PRE¥iOUS RECEiPtS <br />IHiS RECE~PI <br /> <br />BALANCE <br /> <br />PAYEE: CENIRAL OREGON r4OBILE <br />REcE!VEO DY: pr' [YPE: <br /> <br />QUANIi~Y ~'4OUN1 <br /> ¢89-2b <br /> 15,t5 <br /> <br /> $110,95 <br /> <br /> $0.00 <br /> <br />iNVOIC~ 34221 <br />CH~CK ~: 0 <br /> <br />* THIS [5 Nor A PER~IT. THIS APPLICATION fflUST GO THROUGH A RLc'VIE~ PROCESS IA~IERE THE <br />FOLLONING NUST BE COMPLETED. iT IS THE RESPONSiBILiTY OF THE APPLICANT TO ASSURE 1HAT <br />ALL NEC~RY iNFORI'~TiDN HA.~BEEN PROVIDED. <br /> <br /> 5EPfIC: ~Y DArE <br /> RE~ARK~: Iv~"¢EAOE~f <br /> <br /> C['IY JURISOICfION; 8Y ....... O~lb <br /> <br />FR 10 L¢S_10 R~,,10 RR 10 SP <br /> <br />PLANNING ACf[ON: <br /> <br />OFFICE COPY <br /> <br /> <br />