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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-PRONE: 588-7904 <br /> <br /> am performing work on a property I own or occupy, <br /> am a registered builder OR ( ) the authorized representative SIGNATURE OF APPL CANT: <br /> of a registered builder, <br /> The work will be performed by ~ registeted builder, <br /> <br /> this document, <br /> <br /> DATE: 06/17/92 TIME: 10z32:00 <br /> <br />]'ltUA~0R~'. ' 8bN~f~O'dfiS~ YgCb~ 6CCU~ANOY: <br />; ~ViLLE OR 97325 ~Ri~ ~NTY[ <br /> NO <br /> <br />:0~ 0¢ 8UILOING: : N0, 0F BEDB00~S: <br /> , ~UF~TURED ST~C'FU~E ~ ......... ' <br /> <br /> 600 ~ VlE~T DR ' ............................................ <br /> <br /> ~E: ~I-0483 : SiTE NU~ER; 92-02014 <br /> VA~AT <br /> <br /> LOT; <br /> I 29 8S ~ lW ~ AR 48 <br /> JWlOTH'. IOEPTH; AREA; I '~4 CUNITS: AC IRREG. LOT; <br /> <br />TYPE: MANUFACTURED STRUCTURE PERf41T OR APPLICATION NO.* 40249 <br /> <br />CON'fRAC'rOR, NO. <br />HAINKiNS , ROBERT J JR. <br />600 ~ VII-'~*IONT OR <br />PORTLANO, OR 97225 <br />PHONE: 371-0483 <br /> <br />I l'Ef4 <br />I~,NUFACTURED s'rRuc'ruRE PLACEt4P..NF/CONNECTION <br />i~N~UP'ACTURED STRUCTURE STATE FEE <br />i~ANUFACTURED s'rRuc'I'URE STATE E~URCHAREiE <br />~IANUFACTURED STRUCTURE ZONING ~,I..IRCHARGE <br /> <br />rOTAL A,%SESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />C~JANI' i I'Y <br /> <br />Ai~OUNI' <br /> $182.00 <br /> $20.00 <br /> $9.10 <br /> $15.00 <br /> <br />5226.10 <br />226.10 <br /> $o.oo <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE: RECE[PI <br />RECEIVED BY: PB 'fYPE: CHECK ~: 0 <br /> <br />THiS IS A VALID ~IT. ~=~ ,rfl4t;~ ~P~,~R~I.'T,::PEE COVERS ,~E I~P~TI~ ~D ~E REI~P~TI~+ ALL <br />,,B~ING. STAIR I~T~Ti~ ~I~. ~I~L~ ~D ~TRI~L ~TI~ ARE R~IRED 1 <br />~EO U~ ~ ~.,,~E FI~T~ [~TI~:;~.' tF.~ OF. THE If~ ARE IN~PLETE, ~ <br />~DIT,I~ I~P~Ti~ ~ ,~i~ .~ ~I~D; ,~I~,' IS ~IO ~ SIX ~THS ~LY+ R~ ~F <br />~. U~ NR[TT~ ~T. ~ ~, ;~SJ~'~[~, TO THE ~P[~T[~ ~TE OP THE P~[T. <br />~ST~CT[~, EA[~ TO ~1; ,~L'.'~[~ ~ STATE ~ ~D ~R[~ ~ ~UJ~[~ ~o <br />Z~ZN8 ~IN~ THIS P~IT, ~L B~ ~ ~D ~iO. ~/~ <br /> <br /> SETBACk: FR 20 LS 10 ~ 10 RR 30 SP '. ~ (1~] ¢, <br /> ';.. ................... <br /> <br /> ~ALO B. ,~DLEY, ~Ri~ ~NTY BUiLO~NG OFFICIAL '/ BY' . ............................................................ ~ ................... ~..I~ · <br /> <br /> OFFICE COPY <br />FORM # MC 1 ~-~6 REV. 4/~) <br /> <br /> <br />