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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 <br /> <br />Other <br /> <br />I have read and agree to the terms ststed on the reverse side <br />this document <br /> <br /> DAFE: 07/25/92 TINE: 15:49:55 <br />OWNER; TAX LOT: OAT~GO NY'. <br /> ZACtiER GALE S-00109J, 55--92 RESIDENTIAL <br /> <br /> $1Tt~S ADDRESs; boN~"rNuaTiO~ ~PE; OCCUPANCY: <br /> <br /> J, 22&7 DONALD RD NE + CT: ! UGh: b~cuPANTLOAD: <br /> URORA OR 9'/002 uNTY, NO <br /> I , <br /> <br />MANUFACTURED STRUCTURE 3 <br /> <br />SAHE ..... <br /> S~TE NUMBER: 92-02717 <br />PHONE: 678--14S6 VALUATION: <br /> <br /> 16 4S ;LW EFU '4 <br />: 201. i AC NO NO <br /> <br />TYPE: HANUFACTURED STRUCTURE PERHIT OR APPLICATION <br />C~NTRAOTOR. NO. 14922 ~.7, ~ <br /> COMH ~oodBurn Inc <br />285 S Pacific Hwy <br /> <br />PHONE; 981,,514~ <br /> <br />[TEH <br />MANUFACTURED STRUCTURE PLACEMENT/CONNECTION <br />MANUFACTURED STRUCTURE STATE FEE <br />NANUFACTUREO STRUCTURE STATE SURCMARGE <br />NANUFACTUREO STRUCTURE ZONING SURCHARGE <br /> <br />9041466 <br /> <br />~lJ AN T I TY <br /> <br />$20_00 <br />$15.00 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$226.~0 <br />$226.1.0 <br /> $0,,00 <br /> <br /> A ANDE CUE o.oo <br /> <br />FOLLOWING HUS/ BE COMPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ~SSURE <br />THAT ~LL NECESSARY INFORHAT~ON HA8 BEEN PROVIDED. <br /> <br />PLAN REVIEW: BY ......... 2..~__. ......... <br /> <br />CITY JURISDICTION: BY_.~_,,~,~ ..... [)ATE <br /> <br />SETBACKS: ~- ~.o <br /> <br />OFFICE COPY <br /> <br /> <br />