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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 9-7301 <br /> <br /> PHONE:588-514'7 8:00- 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I 8m performing work on 8 property I own or occupy. <br />I:~maregisteredbuilderOR( )theauthorlzedrepresentative <br />of a registered builder. <br />The work will be performed by a registered bvilder. <br />Other <br /> <br /> DATE: 09/04/92 TIME: 16:35:54 <br />°WNER:LIFFLANOER, JOHN & CAROL <br /> <br />SIGNATURE OF APPLICANT; <br /> <br />T 's-ooo <br /> <br />CONSTRUCTION TYPE <br /> <br /> 8851 SMITH RD SE <br />AUMSVILLE OR 97525 <br /> <br />USE oF SUlLD~NUFACTUREO <br /> STRUCTURE <br /> <br />MA~UNG AODR~SS: <br /> <br /> ~290 BALSAM DR S <br /> SALEM OR 97302 WK 378-3738 <br /> PHONE: 363-6418 <br /> <br />SUBDIVISION <br /> <br /> SITE NUNBER: <br /> VALUATION: <br /> <br />92~01640 <br /> <br />LOT: <br /> <br />WIDTH; <br /> <br />BLOCK: SECTION; ' "OWNSHIP: RANGC: <br /> 24 8S 2W SA <br /> <br />c~¥~N T I AL <br /> <br />OCCUPANCY <br /> <br />OCCUPANT LOAD <br /> <br />MAP; <br /> <br />51 <br /> <br />TYPE: MANUFACTURED STRUCTURE PERMIT OR APPLICATION NO: <br />CONTRACTOR, NO. <br />LIFFLANDER, JOHN & CAROL <br />~290 BALSAM OR S <br />SALEM OR 97302 WK 378-3738 <br />PHONE: 363~6418 <br /> <br /> ITEM <br />MANUFACTURED STRUCTURE PLACEHENT/CONNECTION <br />MANUFACTURED STRUCTURE STATE FEE <br />HANUFACTUREO STRUCTURE STATE SURCHARGE <br />MANUFACTURED STRUCTURE ZONING SURCHARGE <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />BALANCE DUE <br /> <br />42117 <br /> <br />QUANTITY AMOUNT <br /> $182.00 <br /> $20.00 <br /> $9.io <br /> $15.00 <br /> <br />$226,10 <br />$226.10 <br /> $o.oo <br /> <br />$0.00 <br /> <br /> PAYEE: RECEIPT <br /> RECEIVED BY: DM2 ........ TYPE: CHECK ~: 0 <br /> <br /> ** THIS IS A VALID PERMIT ~ THIS PERMIT FEE COVERS ONE INSPECTION AHO ONE <br /> REINSPECTIGN, ALL BLOCKING, STAIR INSTALLATION, PLUMBING, MECHANICAL. AND ELECTRICAL <br /> CONNECTIONS ARE REQUIRED TO BE COMPLETED UPON REQUEST FOR THE FIRST INSPECTION. IF <br /> ANY OF THE iTEMS ARE INCOMPLETE, AN ADDITIONAL INSPECTION FEE #ILL BE REQUIRED, <br /> PERMIT IS VALIO FOR SIX MONTHS ONLY. RENEWED FOR 6 MONTHS UPON #RITTEN REQUEST FOR <br /> AN EXTENSION, PR[OR TO THE EXPIRATION DATE OF THE PERNIT. IF CONSTRUCTION FAILS TO <br /> NEET ALL REQUIREHENTS OF STATE LA~S ANO HAR[ON COUNTY BUILDING AND ZONING ORDINANCES, <br />PLANNING ACTION: <br /> SETBACKS: FR_20 <br /> LS lO <br /> RSZiO <br /> RR 30 <br /> <br /> REMARKS: PLACEMENT PERMIT <br /> <br />DONALD E. WOODLEY, HAR[ON COUNTY BUILDING OFFICIAL / BY ............ <br /> <br /> OFFICE COPY <br />FORM # MC 15.56 REV. 4/9O <br /> <br /> <br />