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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 />SIGNAi'URE OF APPLICANT <br /> DATE <br /> <br /> OAig: 08/21/91 [iME:: 14:13:42 <br />OWNER TAX LOT <br /> HOPPER, LINDA 5?706-000 <br /> <br /> CONTRACt CITY UGG <br /> AU~4SVI LLE: NO <br /> <br /> 155 SPRUCE: CI <br />AU~ViLLE OR 97325 <br /> <br />MAILING /~O0~bS~ MANUFAC'f'URE:D StRUCtURE <br /> <br />R-3 <br /> <br /> 2041 KE~INEDY CiRrJLE NE <br /> KEiZER OR 9'/303 WK:~3'18-2801 <br /> PHONE:: 393-8980 SIlg NU~ER: 13884 <br /> VALUA'r ~ ~: <br />LOT BI OCK SECTION TOWNSHip RANGE ZONE <br /> <br /> 20 25 8S 2W ~ <br /> 55 80 SF Y~5 NO <br /> <br />MAP <br /> <br />rYPEt ~,NUFACrURED SFRUCfURE: PE:P, MiF OR APPLiCA['ION NO: 9034805 <br /> <br />CONTRACIOR, NO. 4907 <br />KiLROYS MOBILE HOME <br />2220 NO PACIFIC HNY <br />NOOOSURN, OR~(~ON 97071 <br />~iONE: 371~6820 <br /> <br />IVL/~UFACIUR~D ~IRUCfURE PLACf;~ENF/CONNEC~iON <br />MANUFACfURED SfRUCfURE S]A'fB F~E <br />~tNUFACfURE:O Sf'RUCFURE StArE SURCHARGE <br /> <br />QUAN/~IY <br /> <br />IOTAL ~6~SBD FEES <br />PRE¥iOU8 RFJ2EIPFS <br />THIS RECEiPf <br /> <br />AIvIOUNf <br /> $182.00 <br /> $20.00 <br /> $9. ~0 <br /> <br />$211,10 <br /> $o.oo <br />$2~.'~o <br /> <br />8ALJ~CE DUE $0,00 <br /> <br /> PAYEE:: K,[.LROYS ¢40~,f, LE HOME fNVO,~CE 36489 <br /> RECEIVEO BY: ~ tYPE: iN CHECK ~: 5 E <br />* THiS :[~ NOT A PEf~llT. 11115 APPLICATION NUST GO THI~JGH A REVIi~H PROCEE~ ~,~ERE file <br />~OLLOHJ[NS r, IUST BE CORPLFTED. [T iS THE RESP(~SIRILJ[TY OF THE APPLICANT TO ~RE THAT <br />ALL NF_C~RY INFOI;tf~.TI[ON HAS B£E~I PROVJOEO. ~ ~ F::C(~T ~¢t~-~'~'Tf(_)Li, <br /> <br />SEPIiC: BY DAlE <br /> <br /> CITY JURISDiCTiON: BY DAlE <br />FR 10 LS 10 ~$ 10 RR 10 SP <br /> <br />PLANN lNG ACF iON: <br /> <br />PORM # MC :~llS6 R~v ~ OFFICE COPY <br /> <br /> <br />