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( ) <br /> <br /> 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-PHONE: 588-7904 <br /> <br />, am performh, g work on a property, own or occupy. R F APPL CANT~~~ <br /> <br /> ~ OONTRAOT ~ TY ~ UCB: ~O~OUPANT LOAD; , <br /> ST <br />~U~SV[LLE g~ 97~25 ¢ ~zaN COUNTY N8 <br /> ' <br /> <br />PHONE: ~0- ~ VALUATION: <br /> <br />TYPE: MANUFACTURED STRUCTURE PERNIT OR APPLICATION NO: <br />CONTRACTOR~ NO. <br />HAEVERNtCK, KEN B <br />SAME <br /> <br />PHONE: <br /> <br /> ITEM <br />MANUFACTURED STRUCTURE PL. ACEHENT/CONNECTtON <br />NANUFACTUREB STRUCTURE STATE FEE <br />MANUFACTURED STRUCTURE STATE SURCHARGE <br />MANUFACTUEEB STRUCTURE ZONING SURCHARGE <br /> <br />?$47594 <br /> <br />QUAN'flT¥ <br /> <br />A~OIJNT <br /> $182.00 <br /> $20.00 <br /> .$9.10 <br /> $15.00 <br /> <br />SETBACKS: FR <br /> LS-'~-~ <br /> <br /> SP .... Z <br /> <br /> TO~'AL~SSESSEBrEES $22~,10 <br /> PREVIOUS RECEIPTS $0.80 <br /> TH};S EEOE~P~ $226.10 <br /> <br /> ,BAL~Ni.E DUE, $0.00 <br /> PAYEE: HAEVERNICK, KEN B : :: : RECEIPT 51904 <br /> RECEIVE~ BY: CL CK CHECK ~: 2603 <br /> <br /> ~ TH~S ~S NOT A PERMIT. PROCESS WHERE THE <br /> FOLLOWING RUST BE i:RESPONS[BILITY'OF THE APPLICANT TO ASSURE <br /> THAT ALL NECESSARY [RFORNATIOH::HAS,BEEN:PRO¥IBE~,: <br /> <br />PLANHING ACTION: ~- <br /> <br /> CITY JURISBICTION: BY B~'E <br /> REEARKS: NS/SS <br /> <br />FORM # MC 16.58 REV'. 4/90 OFFICE COPY <br /> <br /> <br />