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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: 588-8147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> I I am ~ resIslered builder OR ( ) the authorized repre.entatlve S[GNATLJRE OF APPLICANT: <br /> ) Oti~er <br /> <br />'bWN~Ri DATE: 1~/12/~3 TIME. 8.1&.,,~8 <br /> ; TAX LOT; ' OATE~ORY; <br /> FIUDNEI_I,. ~ MICHAEL RESIDENTIAL <br /> SITUS AOBRESS: ' O~A~ROO~iON TYPE~ OCCUPANCY: <br /> <br /> ~11 ASPEN QR 5 ,,"~Y~'fCif~: :'d~: OCcoCANr LOA~: <br /> AUHSVILI_E O~ ~7~25 ~ AUHS~ILLE , NO J <br /> <br />'0¢~ OF 8~ILDING'. NO OF 860ROOM8 <br /> HANUFACTURED STRUCTURE ~ <br />~XlLING ADDRESS: ~5~61~1~i6~; <br /> HZLL CREEK ESTATES ffH P~RK <br /> <br /> SITE NU~BER: ~3-03585 <br /> PHONE: 585~8227 VALUATION: <br /> <br />NO NO <br /> <br />TYPE: MANUFACTURED STRUCTURE PERMIT OR APPLICATION <br />CONTRACTOR~ NO. 2079? <br /> MCMIhlNVILLE FACTORY HOMES <br />2050 S NWY 99 W <br />MCMINNVILLE~?7128-~O~ <br />PHONE: <br /> <br /> ITEM <br />MANUFABTUREB STRUCTURE PLACEMENT/CONNECTION <br />MANUFACTURED STRUCTURE STATE FEE <br />MANUFACTUREB STRUCTURE STATE SURCHARGE <br /> <br />TOTAL ASSE$SEQ FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />58557 <br /> <br />QUANTITY AMOUNT <br /> $182.88 <br /> <br /> $9.10 <br /> <br />$211.10 <br />$211.10 <br /> $0.0~ <br /> <br />BALANCE DUE $0.86 <br /> <br /> PAYEE: INVOICE <br /> RECEIVE9 BY: PB .................................. TYPE: CHECK ~: 0 <br /> <br /> ** THIS IS A VALID PERMIT $* THIS PERMIT FEE COVERS ONE INSPECTION AND OHE <br /> REINSPECTION. ALL BLOCKIN§, STAIR INSTALLATION. PLUMBING, MECHANICAL~ AND ELECTRICAL <br /> CONNECTIONS ARE REOUIRED TO SE COMPLETED UPON REGUEST FOR THE FIRST INSPECTTON~ IF <br /> ANY OF THE ITEHS ARE INCOHPLETE, AN ADDITIONAL IHSPEb"TION FEE WILL BE REQUIRED. <br /> PERNIT IS VALID FOR SIX NONTHS ONLY. RENEWE~ FOR 6NONTHS UPON ~RITTEN REOUEST FOR <br /> AN EXTENSION. PRIOR TO THE EXPIRATION ~ATE OF THE PERNIT. IF CONSTRUCTION FAILS TO <br /> NEET ALL REOBIRENENTS OF STATE LANS AN~ NARION COUNTY ~UIL~IH~ AND ZONiN~ ORSiNANCES, <br />PLANNING ACT[ON= <br /> SET~ACKS: FR 1~ <br /> L.S-15 <br /> RS-15 <br /> <br /> REMARKS. MF6 HONE <br /> <br /> DON~L~ E,. WOO~LEY~ MARION COUNTY BUILDING OFFICIAL / BY ...................... <br /> <br /> OFFICE COPY <br />FORf~ # MC 15-56 REV. 4/90 <br /> <br /> <br />