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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::30 <br />24 HOUR CODE-A-PHONE:: 588-7904 <br /> <br />I ~ma registered builder OR~ ~theauthonzed representatwe <br /> <br />The work will be performed by a registered builder <br />Other_ <br /> <br /> have rend and agree to the terms stated on the reverse side of <br /> <br />DAUd: 06/18/91 limb: 16:48:62 <br /> <br /> GAGAfKO, DONALD J, <br /> <br />SITMS ADDRESS <br /> <br /> 150 5COl[ AVE <br />DEfROI] OR 97342 <br /> <br />~ i LE HOME <br /> <br />P.O. BOX 577 <br />DEfROif, OR 9?342 <br />PHONE: <br /> <br />SIGNATURE OF APPLICANT <br /> DATE <br /> <br /> TAX LOT CATEGORY <br /> 90260-475 RESI DEN f i~L <br /> <br /> CONSTRUCTION '-YPE OCCUPANCY <br /> R-3 <br /> <br />DE'f lk~ I f' NO <br /> PATTON 2ND ADDIilON <br /> <br />LOT BLOCK SECTION TOWNSN IP <br /> 1/2 5 1 lo <br /> 118 163 19234. SF <br /> <br />Sfl~- NU~ER: 13089 <br />VALUA F ION: <br /> <br /> 5E RS <br />IRAEG LOT CORNER <br /> NO YES <br /> <br />fYPE: r40~3iLE HOME PERMIf' OF? APPLICAfION NO: <br /> <br />CONIRACIOR, NO_ 36421 <br />KE¥iN'5 BACKHOE SERVICE <br />P.O. ~OX 465 <br />D~FRGIr, OR~Br,,)N 9'7342 <br />PHONE: <br /> <br />$2505 <br /> <br />NF.,~ILE HONIE BASE FEE <br />NIOBiLE HOME 5IA1E FEE <br />MOBILE HONE S'IAFE SURCHARGE <br /> <br />TOFAL A,.%E~ED FEES <br />PREVIOUS RECEiP"YS <br />IBiS REC6IPT' <br /> <br />QUANTITY <br /> <br />AMOUN 1 <br /> $89.25 <br /> <br /> $5,25 <br /> <br />$110,25 <br />$110.28 <br /> $0.80 <br /> <br />BALANCE LXJE $0,,00 <br /> <br />PAYEE; INVOICE <br />RECEIVED BY: CL fYPE: C~ECK ~: 0 <br /> <br />* THiS IS A VALID PER~iT * THIS PE~4IT EXPIRE~ 180 DAYS FROffi ITS iSSUE DATE+ IF <br />CONSTRUCTION CEASE~ FOR A PERIOD OF 180 DAYS,OR IF CONSTRUCTION FA/IS TO NEET ALL <br />REqUiREmENTS OF ~TATE LIVA~ AND r, IARi(~I C~JNTY BUILDING AND ZONING ORDINANCES, THIS PER~I'I <br />5HALL B~CQ~4E NULL ANDVOID. <br /> <br />SEfBACKS; FR 20 LS 5 RS 5 RR 5 5P <br />R~MARKS: IV~ PLACEMNT ..... <br /> <br />PLANNING ACIION: <br />DONALD E. NOODLEY, MARION COUNFY BUiLDiNG OFFiCiAL / BY <br /> <br />~oR~ ~ MO ~s-~ ~EV ,~¢o OFFICE COPY <br /> <br /> <br />