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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 _ ~ ,n ,/ <br /> <br /> n r wn or oecu NT~ ~'~/~~1 ~--~ <br /> I am per orf ng work o a g operty I o PY, <br /> I am a registered builder OR ( ) the authorized representative SIGNATURE OF APPLICA <br /> <br /> The work will be performed by a registered bueder, <br /> Other. <br /> <br /> DATE; 12/2S/92 '1'I HE: 15: 50." ~ 7 <br /> <br /> BURLETGH, J~HES & LEC'[¢~ 5~510946 <br />S$TUS ADDRESS: CONSTRUCTION TYPE; <br /> <br /> J.£982 STE1NKC.,HP RD ~¢E CONTRAOIOITY' <br /> A B HSV'[ L L. E:'.' M 97525 dARIOb COONT ~ <br /> <br /> MANUFACTURE[) 41RUCI'URE <br />MAILING ADDRESS ~~~ SUBDIVISION <br /> PO BOX ~,Bl02 <br /> <br /> PHONE: 393'" a790 <br /> <br />SITE NUMBER: <br />VAI_UATIOHy <br /> <br />CATEGORY' <br /> <br /> F~E,S I [~ERT IAL <br />OCCUPANCY. <br /> <br />33 8S i~ <br /> .666 AC qO <br /> <br />92-04544 <br /> <br />ZONE <br /> <br />MAP¸ <br /> <br />TYPE: HANUFACTURED STRUCTURE PERMIT OR APPLICATION NO; <br />CONTRAC'fGR ,, <br />BURL, Ei.(GH,. JANES & I..E'CI'A <br />PO EIOX J, BL02 <br />SALEH 97305 <br />PHONE -" 395.'"8790 <br /> <br /> ITEM <br />MANUFACTURED S'[RPG'fURE PLACEMEN'F/COBNECflON <br />MANUFACTURED STRUC?'URE STATE CEE <br />MANUFACTURED STRUCTURE STATE SURCHARGE <br />HANUFACTI,JREO S'[RUCTtJF~E ZONING SURCHARGE <br />ifiANUFACTL~RED S'['RUB'['URE TURNPIKE 0/~ BUILDING INSPECTION <br />HANUFACf'UREO STRUCTURE TURNPIKE D/~ PUBLIC WORKS <br /> <br /> TOTAL A'SSEBSED F~'ES <br /> PREVI'OWS RECEIPTS <br /> TBIS RECEIPI <br /> <br /> ~-~ BALANCE BUE <br />PAYEE: EURLEIGH, JAMES & LECTA '~--~ <br />RECEIVED BY: BM~ ...............................................................~ TYPE: <br /> <br />9044598 <br /> <br />Q/JAN 1' I TY AMOUN f' <br /> $181! ,,00 <br /> $20. O0 <br /> $9.10 <br /> $1.5.00 <br /> $,1.00 <br /> %16 ,, 00 <br /> <br />$243 Il 1. () <br /> $0 ,, <br />$ 24,,; Il i .) <br /> <br />RECE [FIT ,46769 <br />CHECK ~;; 5067 <br /> <br /> OFFICE COPY <br />FORM Cf MC 15.56 REV, 4/90 <br /> <br />CITY' 3'(!a I $[)I C f I. )a ::'' ' ' ' ' ~ Y ~ ~ ........ DATE <br />NF:MAPKS- MFG HOHF' & S~'P[IC ...................... <br /> <br />SETBACKS :, F<R,,,../i~CD,./ <br /> R S..lZ~,,," <br /> <br />* THIS IS NOT A PERMIT. THIS APPLICATION HUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST 8E COMPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE <br />THAT ALL NECESSARY INFORMATION HAS BEEN PROVIDED ~_" ~-_" , I_ m. ~4- mo ~.0~ <br /> <br /> <br />