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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-$147 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> I am performing work on a property I own or occupy· SLGNATURE OF <br />I l am a registered builder OR ( )theauthorizedrepfesentative <br /> of ~ registered builder, <br /> <br />CATEGORY'· <br /> <br /> RESI,OEMT I AL <br />OCCUPANCY: <br /> <br /> Wt-SEA£'RES .................... <br />  SITE NUMBER; <br /> PHONE: 678~2174 . ~ VALUATION: <br /> MAP: <br /> <br /> i~7 .................... i'~.¢i~ ................ --5~fCs .................. ~-~:-.~} ............. ~ .......... <br /> ~ ' , <br />........................................... : 2,.~ ~ · --.N0 N0 <br /> <br />TYPE: NANUPACTURE~) STRUCTURE PERHIT OR APPLICATION <br />[,ONTRACIOE~ NO. 38238 <br />Daniel L Csl"v~r <br />1137~ ~],1 Creel( Rd <br />~umsville~ 9'7325-00~0 <br />FHOME~ 769-7744 <br /> <br /> ITEM <br />M4NOFACTURE~ STRUCTURE PLaCEMENT/CONNECTION <br />M~NUF~CTURED STRUCTURE S~TE FEE <br />H~NUFACTURED STRUCTURE STATE SURCI4&R~E' <br />MANUPACTIJRED STRUCTURE ZONING SURCHARGE <br /> <br />QUANTITY AMOUNT <br /> $182.00 <br /> $20.00 <br /> $9,,10 <br /> <br /> $226.10 <br /> $0.00 <br /> $22&.10 <br /> <br /> TOTAL ASSESSED FEES <br /> PREV:[OUS RECEIPTS <br /> THIS RECE'rPT <br /> <br /> BA:I~ANCE: 1)UE $0,00 <br /> PAYEE: BORK~ ALAN ~r:'AT~Ic:~ "::~. RECEIPT 52~38 <br /> <br /> ~ ~HZS IS HOT A PER~IT. TH~S APPLiCATION:HU~T 60 ~ROU6H A REVIEW P~OCESS WHERE THE <br /> FQLLQWIH6 HUST BE COHPLETEB. I;T, IS THE ,RESPONSIBILITY OF THE APPLICANT TO ASSURE <br /> THAT RLL NECESSARY INFORHATION:HAS BEEN PROVIDED,: <br /> <br />LANNZNG AC flOH. ~ , ~ <br />PLAN R?ZEW:~Y ~ SETBACKS= FR/~¢ <br /> <br /> CITY JURISD:[CTION: BY SI,-' ...... <br /> RE;HARKS= NS/SS:AU:NOF'E~ ~:'- ' .......... <br /> <br />OFFIGE COPY <br /> <br /> <br />