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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 / J ~ - <br /> <br /> of a registered buiP~er, <br />?~IOtherThe work will be perfformed by a registered builder. , <br /> ) I have read and agree to the terms stated on the rever~e side of DATE; <br /> this document. <br /> <br />.................... SITUS ADDRESS'. : OCCUPANCY'. <br /> <br /> 11354 J~ WAY SE : <br /> j ~R~ ~NTY~ NO <br /> <br /> ~UFAC'FUREO ST~C'rUR6 <br /> <br /> 600 ~ VJE~T <br /> <br />~WIDTH; [DE~H: J AREA: I .~ J UNITS'. AC ~ IRREG. LOT; <br /> <br />TYPE.. 1'4ANUFACTURED STRUCTURE. PERf4IT OR APPLiCA'rioN NO: 9040249 <br /> <br />CONTRACTOR, NO- <br />HAWKINS , ROBERT J JR. <br />600 .SN Vi~'I~C4ONT DR <br />PORTLAND, OR 9?225 <br />PHON E ~* 371-0483 <br /> <br />il'ER <br />I~NUFACTURED STRUCTURE PLa,C,~,IENT/CONNECTiON <br />t~N~IUFACTURED STRUCTURE ~I'AI'E FEE <br />MANUFACTURED STRUCTURE STATE SURCHARGE <br />I~1ANUFAf~I'URED STRUCTURE ZONZNG SURCHARGE <br /> <br />TOTAL A.~S~ED FEES <br />PREVi~JS RECE[PT~ <br />THIS RECEIPT <br /> <br />QUANT I T Y <br /> <br />PAYEEt HAWKINS , ROBERT J. JR; <br />RE~CEiVED BY: CL <br /> <br />AFK)UNI' <br /> <br /> $20,0O <br /> $9.10 <br /> <br />$226.10 <br /> $o.oo <br />$228+10 <br /> <br />BALANCE DUE $0.00 x <br /> <br /> R~EIPT 42288 <br />TYPE: CK CHECK ~: 1007 <br /> <br /> THIS. 1S NOT A PE~liT+ THIS APPLICATION HI.~T GO THRQUi~'i A REVII~ PROCE,.%S I~-tERE THE FOLLOHIt <br />I~Li~T 8E COIqPLETI=n. IT IS THE RESPi~ISiSILITY Of= THE APPLiC/~T TO ASSURE THAT ALL NECEE~SARY <br />IN~OR~ATION HAS B~r.~N PROVt'D~-'D~ <br /> <br />SEPT[C: BY,~ .................. DATE.___~'__//__,.~.,~,_ff..,~ CITYJVR[SPl.CTioN: r~y ................... DATE ............................... ,. <br /> L <br />ZONING: BY~ DA'FE_._~_("z.~.~I,,,. SETBACKS: F'R..___~_,~.. LS,,,.~,,~ ..... m...._~..e ....RR,-~,,,~ ........ aP ................ <br />RP3~IARKS.+ PL~AOE~ERT - <br /> <br />PLANN, jNG ACTION: <br /> <br />FORM # MO 15,96 REV, 4,90 <br /> <br />OFFICECOPY <br /> <br /> <br />