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MARION COUNTY BUILDING iNSPECTION <br />SENATOR BLDG NO 226 <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 />I ha~o ¢oad and agree to the terms stated on the reverse side of <br /> <br />i';5~,'kil-~TE: 06/'14/gl TIME: 10,;06 .' 3'5 <br /> <br /> 250 gWERGREEN OR <br /> AuMsvI LLE OR 97325 <br />USE OF BUiLDiNG <br /> <br /> PHONE: 769-7744 <br /> <br />W~DTH 5 ]DEP~II AREA ~5 UNllS <br /> 55¢ 89 i <br /> <br /> ! <br />SUeOi¢i~0N ....... <br /> <br />EYERORE~]~ f~I"'~TATtES' <br /> <br />SiTE NUMBER: 13069 <br />~AN~V~ALUA] iON :, zb~ ................... !MAP <br /> <br />{RRE~ LOT ': C~ ER ..... <br /> <br />tYPE: f~81Le HOME <br /> <br />CON1RACTOR, NO. 38238 <br />SANTI~ MO~iLE H0~IES <br />11373 MILLCREEK RD SE <br />AUfCCS~ILLE OR 9?325 <br />PHONE: 769-7744 <br /> <br /> iF6N <br />¢¢KJBILE HOME 8A~E FEE <br />I~.'~iLE Hr,.~'4E STATE FEE <br />M0~iLE HONE STATE SURChHARGE <br /> <br />PAYEE: s/~lrI,~l M(~XLE HQ'~IES <br />RECEIVED BY: PR <br /> <br />PER~iT OR APPLICATION NO: 9032965 <br /> <br />TOTAL A,~ED <br />PREVIOUS RECEiPtS <br />THIS RECEIPT <br /> <br />(~XJANfIIY <br /> <br />~89.25 <br />15.75 <br /> $5.25 <br /> <br />$110.25 <br /> $o.oo <br />$~o.~6 <br /> <br />BALANCE OUE $0.00 <br /> <br /> INVOICE 34762 <br />TYPE¢ iN CHECK ~: 0 <br /> <br /> THIS IS NOT A PEI~IIT. THIS APPLICATION ~U~T GO ~i~3U(~H A R~I~ P:~ ~E~ THE <br />~L~i~ ~T BE ~PLETED. IT IS THE R~XBILI~ ~ THE ~PLi~T TO ~ THAT <br /> <br /> 5EPT1C: BY DATE .................. CI]Y JMRISDtC71~: BY ............. DAtE <br /> <br /> Z~NG: BY ~f'E SEtBACk: FR 10 ~ 10 ~ 10 RR 10 SP <br /> RE~R~: ~"'~E~ ~ ................. <br /> <br />PLANNING ACFION; <br /> <br />OFFICE COPY <br /> <br /> <br />