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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 9"7301 <br /> <br /> PHONE: 588-5147 8:00 - 4:S0 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am performing work on a property I own or occupy. <br />larn a registered builder OR ( ) the authorized represeAtative <br />of a registered builder. <br />The work will be performed by a registered builder, <br />Other_ <br /> <br />I have read and agree to the terms stated on the reverse side of <br /> <br />SIGNATURE OF APPLICANT; <br /> DATE: <br /> <br /> OWNER: DRI'E-' 02/,1,8/9;5 TIHE:: i2:22:5:5 fAX/bT: <br /> <br /> IIILL$, HARDLO & YVONNE 67005-.000 <br />: SITUS ADDRESS: CONSTRUCTION TYPE; <br /> <br />CATEGORY: <br /> <br /> UGB <br /> 19,5 G(JYMOORE DR CONTRADTDITY: <br /> DETROIT OR 97542 DEl'ROIl' <br />USE OF BUILDING'. <br /> <br /> MANUFACTURED STRUCTURE <br />MAILING ADDRESS; <br /> <br />SUBDIVISION: <br /> <br />NO 0I- <br /> <br /> ,5 <br /> <br />LOT: <br /> <br />PO BOX 465 <br />OETROiI' OR 97~42 <br />PHONE: 854-$44] <br /> <br /> BLOCK: SEDTtON: <br /> <br /> MACKEY CREEK TRACf <br /> <br /> SITE NUMSER: 9S-OO&27 <br /> VALUATION: <br /> <br />TOWNSHIP: RANGE: ZONE: <br /> <br />MAP: <br /> <br />W~DTH:2 <br /> <br />211 114 24054 SE NO , NO <br /> <br />TYPE: HANUFACTURED STRUCTURE <br />CO~-[ RAC T'OR ,,,NO. 4~465 <br />ROBERT CRESsEY <br />14262 S_ MAPLE GROVE <br />MOI._AL LA ,, 97058 <br />PRONE: 829,,,'~958 <br /> <br />PERHIT OR APPLICATION NO: 9045399 <br /> <br /> ITEM <br />MANUFACTDREO STRUCTURE PLACEHENT/CONNECI'ION <br />MANUFACTURED S'FRUCI'DRE STATE FEE <br />N~NUFACTUREB STRUCTURE STATE SURCHARGE <br /> <br />TOTAL. ASSESSED FEES <br />PREVIOUS RECEI, T~ <br />THIS RECEIPT <br /> <br />QUANT `1] 'FY AMOUN 'f' <br /> $1,82 ,, O,J <br /> $20. DO <br /> $9. 'LO <br /> <br />$2i.I.10 <br />$21:1_10 <br /> <br />BALANCE DUE :l;O.O0 <br /> <br />P~XEE: HIL. L~,, !flAROLD & YVONNE /~ INVOICE 47~81 <br /> <br />* THIS IS NOT A PERMIT. THIS APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST BE COMPLETEO. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE <br />THAT ALL NECESSARY INFORNATION HAS BEEN PROVIOED. <br /> <br />PLANNING ACTION: ..- <br /> 8ETSACKS: <br /> FR <br /> 20 <br /> ..ONIN :~:; E~Y .................... <br /> <br /> DITY JUR[SOICTTON: EY DATE RR~15 <br /> R,..MA/K,~ HANUF.,, HOME E'"~Tjq~(] <br /> <br />FORM # MD 15-58 REV, 4/9~ OFFICE COPY <br /> <br /> <br />