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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: 588-514'7 8:00 - 4:30 <br /> 24 HOUR CODe-A-PHONE: 588-7904 <br /> <br />I sm pe¢torming work on a property I own or occupy <br />I am a registered builder OR ) he au her zed rep esen ave SIGNATURE O~ APPLICANT: <br />Of a registered builder, <br />The work wis be perfformed by a registered builder, <br />Other <br />I have read and agree to the terms stated on the reverse side of DATEI <br />this document, <br /> <br />,.-8wh~)~ f P_: :~ 0/.03/N 1 ~':£~1t~.;... 1.2 ~.55: ~ <br /> "~ LOT <br /> T'H~ON. 5~L~Y <br /> ~FTUS ADDRESS· "6d~S~b~+'ON TYPE <br /> <br /> 215 YEN C"[ <br /> AUIV).SV 1LLE <br /> <br />USE OF BUILDING; <br /> <br /> 34[- ~0~'~ ~bT CITY: <br />OR 9?325 <br />..................................... JAUr, I~F-I. GL-.E <br /> <br /> CATEGORY' <br /> <br />5'7706-000 <br /> <br /> .B~3 .......... <br /> JG~ · OCCUPANT LOAD: <br /> <br /> NO OF BEDROOMS <br /> <br />MAILtNG ADDRESS MANUFACTURED STRUCTURE <br /> <br />.AUM.~Vi LLE UN <br />:-'HONE: <br /> <br />34 :~b . <br /> Lib 1 (][ SbUD _ <br /> <br />SBBDIVISION ..................... 3 -" <br /> <br /> VALUAT i ON: <br /> <br /> SF NU ' YES <br /> <br />'(YPE: MANUFAC'fURED Sf'RUCfURE PERf41I' OR APPLiCATiON NOt 9035?84 <br /> <br />CON'~RAC'fOR, NO, 38238 <br />SAN'¥1,4~4 MC~ILE HOME5 <br />113'73 MILLCN~EK RD SE <br />AU~CSVIL. LE OR 97325 <br />PHONE: '769~'/'744 <br /> <br />I'F~M <br />MANUFACIUR~O SFR%IC'FURE PLACEM~N'F/CONNEC'IiON <br />~ANUFACTURED ~TRUC'T'URE STAT'E <br />MANUFAC'fUR~D S'fRUC'fUR~ 3'FA'F'E SURCHARGE <br /> <br /> TOTAL ASSE,S,SEOFEES <br /> PR~WIf.,~JS RECEIPTS <br /> : THiS RECEIPT <br /> <br />· BALANCE <br /> <br />QUANTITY <br /> <br /> $182.00 <br /> $20,00 <br /> $9,~0 <br /> <br /> $2'1~.10 <br /> <br /> $0- 00 <br /> <br />37896 <br /> E <br /> <br />PAYE~= S/~Nf'IAN rq~iLE HO~ <br /> iNVOICE <br />RECEIVED BY: PS ....................... ~.-=~%:~i~=== ........................... 'TYPE: IN CHECK ~: 5 <br /> THiS IS NOT A P~R~IIT. THI$:'APPLICATIONN1LLS~ GO ~ A R~I~ P~ ~RE THE <br />~LL~iNG ~ST 8E ~L~D.:. ~T:;~<~E R~SiBILi~ OF THE APPLI~T TO ~RE THAT <br />~L N~RY iN~Ti~ H~iBE~ P~VlOEO. <br /> <br />5EP'I'IC: 8Y <br /> <br />ZONING: BY 0A'fE SE'I'SACKS: <br />RENARKS= NOS~'EE'"'ROC;'IE PLACEmEnT ........... <br /> <br />PLJLNNiNG ACTION: <br /> <br /> CiTY JURiSDICf'iO1N: BY DA¥'E <br />F'R 10 LS 10 RS 10 RR 10 SP <br /> <br /> <br />