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MARION COUNTY BUILDING INSPECTION
<br />SENATOR BLDG, NO, 225
<br />220 HIGH STREET NE
<br /> SALEM, OREGON 97301
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<br /> PHONE: 588-5147 8:00 - 4:30
<br />24 HOUR CODE-A-PHONE: 588-7904
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<br />t am a registered builder OR the authorized regresentative
<br />of a registered builder,
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<br />Other.
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<br /> ....' 876':~ L,,f:;¥E];~Jq F~D ,,,1,,,0: CONTRACT CITY: ¢' UGa: mi OCCUPANT ~OAD:
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<br /> F'.'(.- 8JqlJ~: ~ S62""4f~7S VALUAT Z ON:
<br />WtDTH: :DEPTH: ( A.~ uNmT~c,,> I m~, LOT: CO~R:
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<br />TYPE: MANUFACTURED STRUCTURE
<br />
<br />!.. ]%lC;.0, ii:.;()
<br />2'5~f~ 'IAFIKE'f' ,?T NE
<br />SALEM O!R 97565.
<br />:'HONF':
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<br />PER~TT OR APPLTCATI'ON NO.' ?045¢7iit
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<br />H.ANLIFAC-f'LJPED S'T;:;:UCTLil;;~I;-: PLACEHE'NT/.C, ONNEC1.';I;BN
<br />,~JAt,¢4JF"AC'TUFdi;~) STRUC;TURE STATE" FEE
<br />hJANI~F'~[,'."f't/I,~ED S'I'[:U.]C'f'URF_;] STATI:7, Sf`JRf`;i-IARGE
<br />ltANU)::'ACi"UF4[!:)'} STRUC'TLJI;:E 7. ON:iN8 SIiF~'CH~RGE
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<br />TOTAL Aqe ¢.'o~'_',~
<br /> .......... ,~ F I;_:]!:_' S
<br />'TH]:S R;' ".."'"~:'
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<br />Q U A N 'f' ]; T Y
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<br />$,:.J. 6.
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<br />I r',Vl..~,. :,,.J.,{GC)o UFD l ..............
<br />!:~'EC V:t BY: c1, , . ,~:,LE,,,-' 4.8~9'7
<br />.................................................................. - .................................................................... lYf,,.. C,~ t.,~h...,.,k 4,,, ¢~,
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<br />THAI, ~L NECESSARY INFORUATiON HAS ~EEN PR~V~ED. ~ ~
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<br />....... ~u,k,.~. MS/SS, o ~ DARI, ~,,ZB.h~L ~Fi~5'"~N~-~'];L, WETF~ REPLAEEMEiYT ~v,. ...............
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<br />Fo..,~ vc i~.s~ ney. 4/~o OF FICE COPY
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