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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, 225 <br />220 HIGH STREET NE <br /> SALEM, ORI:GON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am a registered builder O1~( ) theau~orlzed representative <br />of a registered builder, <br /> <br />Other, <br /> <br />I have read and agree to the terms stated on the reverse side of <br />this document. <br /> <br />SIGNATURE OF APPLICANT: <br /> <br />OWNER; DA'f~-'.~: 0, /,~.6/93; TIHE: [I,S:~J ~:97 TAX LOT: <br /> <br />2ATEGORY <br /> <br /> 4~5 SANTIAM AVE ],IW <br /> D~ 1 R£ 1 f 0R..._..97~2 <br />USE OF 8UtLOING; <br /> <br />CONTRACT CITY; JG8 O~J'r LOAD. <br />~)ETF<OIT <br /> <br />: ~RtUNG ^DD~IIJFAI'''I URED ,* fRUCTIJRE <br /> <br />SU BDIVISIOh ~ <br /> <br /> PO BOX 11~66 <br /> HINES OR 97738 SITE NUMBER: 93-Be&e9 <br /> F'HONE ~ ~7 ~- L~'.,!39 VALUAI'ION: <br />LOT: BLOCK: SECTION: TOWNSHIP: RANG~ ZONE'. <br /> <br />WIDTk~;~ DE PT[~' AREI~i' ..... , UN TSP. 0 R F(~, LOT'. CO RI~I~ R <br /> 't 4~ '1'~"1 .........'i'137';~',"~". ....... ,SF ............. ~n '¢F'~ · .. <br /> <br />TYPE: NANUFACTURED STRUCTURE <br />COIIIRAC ~OR.~ NC),, <br />BEN'I'0N,~ DENNIS & LgI,,A <br />FO:~ BOX 866 <br />HINES OR 977~8 <br /> <br />PERMIT OR APPLICATION NO= 45,~98 <br /> <br /> IIEH <br />M~I,IUFACTIJREI) STRUCTURE PL~CEHENT/CONNECTION <br />M~I~UF'RC. 1URI..ZD ~iRUCTURIE ,~T~TE FEI'_'. <br />~NUF~CfURE~ STRIICTURE STATE SURCH~F~GE <br /> <br />T01'AL AS~E~,~I:.ir) FEES <br />PREVIOUS RELE].~ 1S <br />1HI~ RECEIPT <br /> <br />BALANCE DUE <br /> <br />QiJAP,'f )i TY AHOLINT <br /> <br />$211.10 <br />$23.1.19 <br /> $0.00 <br /> <br />II4VOICE <br /> <br /> PAYEE;: <br /> RI?'TCI','.'I~/E;0 BY: F'B I'YPE: CItE'.CK <br /> *A THIS IS A VALID PERMIT ** THIS PERMIT FEE COVERS ONE INSPECTION AND ONE <br /> REIHSPECTION. A I , T L O ~ C TR AL <br /> ANY OF THE ~TE~S ARE ~HCOHPLETE~ AN ~DD[T[OHAL ~HS~CT~ON FEE ~[LL <br />PgRN~T ZS VAL~ FOR SIX HOHTHS ONLY. REHE~E~ FOR & HOHTHS UPON ~R[TTEN REQUEST FOR <br />AN EXTENSION, PRIOR TO THE EXPIRATION DATE OF THE ~EHIT. ~f CONSTRUCTION FAILB TO <br />flEET ALL REQUIREHENTS OF STATE LAWS AND EARION CQ~Y BUILDING AND ZONING QRDINANCEB, <br />PI..ANNIN(; ACTIONr. <br /> SEI'~ACKS: FR 5 <br /> <br /> R9 5 <br /> <br /> I(:IIIAI_.D F,, W00DI_.EY,, MARION (014TY b ]I,I)IN5 0F'F'%CI~L / fly <br /> <br /> OFFICE COPY <br />FORM # MC 15.§s REV, 4/90 <br /> <br /> <br />