Laserfiche WebLink
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 /> I sm performing w0¢k on Sproperty I own or occupy, <br /> I am a registered builder OR the authorized representative SIGNATURE OF APPLICANT; <br /> of a registered builder. <br /> The work will be performed by a registered builder, <br /> Other <br /> I Save read and agree to the terms stated on the reverse side of [;)ATE'. <br /> this document. <br /> <br /> OA'T'E= 06/15/92 'l'l~Ez 12z28:52 <br /> ~'FH, ~ER ~ ~ RESI OENI'iAL <br />¢SITUS ABDRESS'. CONSTRUCTION TYPE; ~ bbcumAmbv: <br /> <br /> 110 ER[N STREET <br /> OE'f'~tT OR 97342 CONTRACT O~Y; i UGB; i OCCUPANT LOAD; <br /> DETROIT NO <br /> USE OF BUiLbJNG; ' :N0. OF 8EDR00~S: <br /> <br />MAILING ADDRESS: <br /> <br /> PHONE: 854-3?28 i SITE NUf, IBER: 92-02222 <br /> [ VALUA'r I ON: <br /> <br /> , SLOCK; TOWNSHIP; , <br />LOT: !SEbTI~: ~ I i~,~N'~ i'~6N~i : MAP; <br /> 1 J 10 ! 5E ~ 105 <br /> 110 11000. . SF i NO~ 1'40 <br /> <br />TYPE; NANUFAC'T'URED STRUCTURE <br /> <br />OON'f'RAC'¥'OR, NO. <br />ROI'H, ROGER <br />SANE <br /> <br />PHONE: 854-3?28 <br /> <br />PERFIiT OR APPLICATION NO: 9040634 <br /> <br />! 'r PG",l <br />~,NUFAC'rURED .~5'rRUC'T'URE PLACF..~EN'f'/CONNEC'riON <br />F4ANUFACI'URED STRUCTURE STATE FEE <br />NANUFACTURED ~TRUC'I'URE STATE ~dRCHARGE <br /> <br />PAYEE: RO'f'H. ROGER <br /> <br />QUAN'T'i'1'Y <br /> <br />AIv~OUNf <br /> $182.oo <br /> $20.00 <br /> <br /> TOTAL A2"""""""""""""""""S~ESSEB::EEES <br />· PREVIOtJSRP.;CEiP'~8 . <br />'f'Hi$ RECEIPT <br /> <br /> OAL.N'4CE $0. O0 <br /> INVOICE 42666 <br /> <br />RECEIVED BY: CL TYPE: iN CHECK ~; 0 <br /> <br /> THiS SS NOT A PEI;~IIT. THIS APPLiCATiON I~USTGO, THROUGH A:REVIEN PROCESS ~rlERE THE FOLLO~iN <br />t,IUST BE COI~IPLETED. IT I~ RESPONSiBiLITy, OF,THE APPEiCANT TO ~RE THAT ALL NECE~xa. RY <br />INP'ORI~IATION HA~BEEN PROVIDED. <br /> <br />SEP'I'IC: BY... CiTY JURiSDiCr'iON~ BY DATE <br /> <br />ZONING: BY DATE SE'rBACKS= FR L$ R~ RR SP <br />REIVlARKS: F~OB~'EE'"'ROY~E .................................................................................................................................. <br /> <br />PLANNING ACTION; <br /> <br /> OFFICECOPY <br />FORM # MC 1 ~-~6 R~V, 4/~0 <br /> <br /> <br />