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MARION COUNTY BUILDING INSPECTION <br />SENATORBLDG NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 9'/'301 <br /> <br /> PHONE: 588-5147 8::00 - 4::30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />DARE; 02/13/92 tif'4E: 12t12:03 <br /> <br /> MiCHAELSON, DALSY <br /> <br /> 29O EWERGREEN DR <br />AUM,SVI LLE OR 9?325 <br /> <br />SIGNATURE OF &PPLICANT <br /> <br />DAtE <br /> <br /> TAX LOf <br /> 57706-000 <br /> CONS (RUCI ION TYPE <br /> <br />CONTRACT CiTY UGB <br />AUD1SViLLE NO <br /> <br />CATFGORY <br /> R~i BEN I i AL <br />OCCUPANCY <br /> <br />OCCUPANT LOAB <br /> <br />MAILING ADDRESS 5INGLE FAI~IlLY DWELLIN67~ SUBDI'ClSION <br /> <br />3 <br /> <br />EVERGREEN E,~IAIE',$ ~ PARK <br /> <br /> PHONE: 749-??44 SIrE NUFEIER: 92-80?54 <br /> VALUAIiON: <br />LOT BLOCK SECTION ~OWNSHIP RANGE ZONE <br /> 9 25 8S 2W ~ <br /> 55 85 4675. SF NO NO <br /> <br />MAP <br /> <br />TYPE: ~UFACFURED SrRuCrURE PEF~If OR APPLiCAFION NO: 38309 <br /> <br />CONTRACTOR, NO. 38238 <br />[,~nfe"l L Car, vet' <br />11373 Mill Cr'eek Rd <br />~iJn'~vi r le, 97325-0000 <br />PHONE = 'T69-774~, <br /> <br /> IfEM <br />~ANUFACFURE0 SIRUCI'URE PLACErfl~T/CONNECI'iON <br />t,IANUFAC'fURED SFRUCIURE S1AIE FEE <br />M~NUFACFURED srRUCFURE SFAFE SURCHARGE <br /> <br />1OTAL A.SSE~ED <br />PREVIOJS RECEIPTS <br />THiS RECEIPT <br /> <br />QUANllf'Y At~JUNI <br /> $~82.09 <br /> $20.00 <br /> $~.~o <br /> <br />PAYEE: <br /> <br />$211.10 <br />$~11.10 <br /> $o.oo <br /> <br />BALANCE DUE $o.oo <br /> <br />iNVOiCE <br /> <br />RECEIVED aY.' r~2 TYPE: CHECK ~t: 0 <br /> <br />~ THIS iS A VALID PE~IT ~ THIS ~IT ~E ~ ~E iNSP~TI~ ~D ~E REI~P~TI~. ALL <br /> <br />~ITI~AL ~ ~I ~R THE FI~T i~P~TI~+ IF ~ ~ ~E ITB ~ i~TE, <br /> <br />.~~ ~RITT~ R~T ~R ~ ~T~S~, PRIOR TO THE ~P~TI~ DATE ~ THE <br /> <br />SE'IBACK,,,S~ FR 10 L~ 15 RS 15 RR 10 SP <br />REMARKS: MO~ILE Hf,,)C'IE PLACEREN1 ............... <br /> <br />PLANNING ACfION: <br />OONALO E. ~NEYDOLEY, MARION COUN1Y BUILDING OFFICIAL / BY <br /> <br /> OFFICE COPY <br />FORM # MC 15-56 REV <br /> <br /> <br />