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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: 58847904 <br /> <br />of a registered b(dlder, <br />The work will be performed by a registered builder. <br />Other, . <br /> <br /> ~20 EVERGREF~"4 DR <br /> AUM,15V f LLE OR 9?325 <br />I,J$B OF BUILDING: <br /> <br /> TAX LOT; <br /> 5'7706-000 <br /> CONSTRUCTION 'rYPE: <br /> <br />~ONfRAC'I CitY: UGB; <br />AUtv~V I LLE NO <br /> <br />CATEGORY: <br /> RESiDEN F 1 AL <br />: OCCUPANCY: <br /> <br />: OCCUPANT LOAD: <br /> <br />MANU FAC 1FU EEO ~,T RUC'FU RE <br /> <br />EVERGREEN MOBILE PARK <br /> <br />3 <br /> <br /> PHONE: <br /> <br />LOT: <br /> 37 <br /> <br /> SITE NurvlBER: 14704 <br /> VALUA f' I ON: <br /> BLOCK: 'SECTION TOWNSHIP: RANGE'. ; ZONE: <br /> <br /> 25 85 2N Ri4 <br /> DEPTH: , AREA: UNITS; iRREG. LOT'. EG(~RNER; <br />55 85 4.675. SE , NO NO <br /> <br />MAP: <br /> <br />'IYPEt IMANUF'AC'rURED 5'rRUC'f'URE PER~,iT OR APPLICATZON NO.- 903'7410 <br /> <br />CONTRACTOR, NO. 38238 <br />Daniel L C~r~vep <br />'11373 Mil'/ Creek Rd <br />Aummvfi 't "~e, 91'325-0000 <br />PHONE: ?89-??4,4 <br /> <br /> l'f'ElVl <br />fCANUFAO'I'UREB ~'fRUC'fMRE PLAC'E~EN'I'/CONNEC'~ON <br />r4ANUFAC'T'URED S'T'R:UC'T'URE S'I'AT'E FEE <br />r4ANUPACTURED STRUCTURE ~'f'A'f'E .~RCHAR~E <br /> <br />TO'TAL A~E~ED FEES <br />PREVIOUS RECE,[ PT.'S <br />THIS RECEIPT <br /> <br />8ALANCE OtJ~ <br /> <br />PAYEE: fg.~nie"l L Carvem <br /> <br />QUANFITY AMOUNT <br /> <br /> $20.9U <br /> $9.10 <br /> <br />$211,10 <br /> $0.90 <br />$211.10 <br /> <br />$0.00 <br /> <br />iNVOICE 39376 <br /> <br />RECE~VGD BYt PqB ..................................................................................... TYPE: IN CHECK ~: 0 <br /> <br /> THis IS NOT A PERt,liT. THiS APPLICATION NUST GO THROUE~i A REVIEH PROCE.S~ I~HERE THE FOLL~X.~/iN <br />~I.JST BE CO61PLETED+ iT IS THE RESPONSiBILiTY OF THE APPLICANT TO A.,..~E~RE THAT ALL NECE.~SARY <br />INFORIAATION HAS BEEN PROVIDED. <br /> <br />SEPTIC: BY ..................................... DAIE .................................................. : ..... CiTY JURISDiC'fION: BY ........................... DA'rE ......................... <br /> <br />ZONING: BY DATE 3E'rBACK~: PR 10 LS,,,15 RS 15 RR ~0 8P <br />REMARKS: MOB1'EE-"RO~E PLACEmEnT .................................. <br /> <br />PLANNING AC1 iON: <br /> <br />OFFICE COPY <br /> <br /> <br />