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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-PHONI=: 588-7904 <br /> <br />] bm performing work on ZORroperty I own or occupy <br />I am a reg,s~ered builder ( )the author'zed representative SIGNATURE OF APPLICANT ..... ~-_._ ........... <br />of 8 registered builder, <br />The wock will be porformed by a registered builder. <br /> <br />OR.._?Z~02 . <br /> <br /> 11656 FAt,CON CT <br />A!!RSRA <br /> <br />OONTF~AOT C~T~ UG8 ~, O~)t~t,J~ANT.., LOAD: <br /> <br /> MARION COUNT-YL-NO ,~ ~ I ,~o <br /> OF'BEDROOMS <br /> <br />SUaOIVI$10N ~ <br /> <br />MAiLiNG AOOFI~'~'t'' L FACTURFD STRUCT .1RE <br /> <br /> 20 WAI,,,KING WOOl) OR <br /> LAKF:; 081~Ef;O.~ O~ 97835 <br /> PHONE= 656-7918 <br />LOT= ; 8LOCK: ~TION TOWNSHIP <br /> <br />,CENTRURY MEADOWS <br /> <br /> SITE NUM])ER: 9~-~998 <br /> <br />TYPE: MANUFACTURE]) STRUCTURE <br />COI,ITRACT~R. NO..7S977 <br />LAMAtN I..ONSI'F(UCTION <br />&!86 SE 4'l'H <br />~ROSI'~)ALE., 970 _68.,,.880 r,J <br />FHONE: 768-,'773& - ' <br /> <br />PERMIT OR APPLICATION NO: 9045944 <br /> <br /> ITEM <br />8ANUFAC'fWRED STRUCI'URE PLACEMENT/CONNECTION <br />HANU',-'ACTURIEO STRWCTURE SI'ATF' FEE <br />MANE~FACTUREEI) STRUCTURE STATE SLJRCI"IARCE <br />MANUFAC'TURED STRUCTURE ZONiI,IG SUF(CHARGE <br /> <br />QUAN'f l: TY <br /> <br />AHOUNT <br />$182,80 <br />$20.08 <br />$9.18 <br />$!5,60 <br /> <br /> fO'fAt. ASSES?D <br /> :'REV];Ot. S RF.[,EIPT.S <br /> THIS Ir(E, CE I F'T <br /> <br /> BALANCE DU~] $8.0~ <br />PAYEF: PARK'.!;N ELECTR.TC lng RECEIF:"I' 4 ~' ' 48" <br /> <br />$,.~6.10 <br /> $8,80 <br />$226,, t0 <br /> <br />RECE:[VED BY;; F'M .............................................................................. 'I'YF'E: CK CHECK 4~; 1474 <br /> <br />~ TH~S ~S NOT A PERMIT. THIS APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLSWING MUST BE COMPLETE]). IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE <br />THAT ALL NECESSARY INFORMATION HAS BEEN PROVIDE~. <br /> <br />PLANNING ACTION: <br /> PLAN REVIEW: BY DATE <br /> <br /> DATE ................................. <br /> <br /> CITY JURI,W)IC'I'ISiL :[~Y DAT~' <br /> RI{HARKS: MF'[; HOME .................................................. <br /> <br />SETBACKS: <br /> <br />FORM # MC 1~-56 REV, 4,'~0 OFFICE COPY <br /> <br /> <br />