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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: 588-5147 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. <br />I am a resistered builder OR ) the authorized representative <br />of a registered builder, <br />The work win be performed by a registered buirder. <br />Other <br /> <br /> J have read and agree to the terms stated on the reverse side of <br /> tl~s document, <br /> <br /> DATE'.' lg/12/9% TINE~ 8."18:26 <br />OWNER: <br /> CONNIE NEELEY <br /> <br />SIGNATURE OF APPLICANT: <br /> <br />DAYE: <br /> <br /> 3~4 ASPEN DR <br /> AI,INS¥I LLE OR <br /> <br />USE OF BUILDING: <br /> MANUFACTURED STRUCTURE <br /> <br /> HILL CREEK ESTATES <br /> AGENT: CRAIG LUCAS-SANI'IAH HOMES i ............... <br /> 76?-7744 SITE HUHBER: 9~-G~479 <br /> PNONE: VALUATION: <br /> <br /> RESIDENTIAl_ <br /> <br />97,325AUMSVILLE <br /> <br />LOT: BLOCK: ' SECTION: TOWNSHIP: RANGE~ ~ON~; MAP: <br /> 55 ~ ~3: 5115. SF NO NO <br /> <br />TYPE: HANUFACTURED STRUCTURE <br />CONTRACTOR~ NO. 382~8 <br />Daniel L Carver <br />1137~ Mill Creek Rd <br />Al,~msvi],le. <br />PHONE:: 76~-7744 <br /> <br />PERNIT OR APPLICATION HO: S8582 <br /> <br /> ITEM <br />HANUFACTiJRED STRUCTURE F'LACEMENT/CONNECTION <br />MANUFACTURED STRUCTURE STATE FEE <br />MANUFACTURED STRUCTURE STATE SURCHARGE <br /> <br />QUANTITY <br /> <br />AMOUNT <br /> $182.00 <br /> $20.00 <br /> $9.10 <br /> <br /> TOTAL ASSESSED FEES <br /> PREVIOUS RECEIPTS <br /> THIS RECEIPT <br /> BALANCE DUE <br />PAYEE: INVOICE <br />RECEIVED BY: PB TYPE: CHECK ~: 0 <br /> <br />$211.10 <br />$211.10 <br /> $0.00 <br /> <br />$0.00 <br /> <br /> ** THIS IS A VALID PERHIT *~ THISPERHIT FEE coVERs ONE] INSPECTION AND ONE <br /> REINSPECTION. ALL 8LOCKIN~STAiR INSTALLATiON.'PLUHB[H6~ HECHANICAL. AND ELECTRICAL <br /> CONNECTIONS ARE REQUIREDTO:DE COHPLETEDUPON REQUEST FOR THE FIRST INSPECTION. IF <br /> SHY OF THE ITEHS ARE INCONPLETE~ ANADDITtONAL INSPECTION FEE WILL BE REQUIRED. <br /> PERHiT is VALID FOR SIX HONTHS OHLY.: :REHE~ED FOR 6 HONTHS UPON ~RITTEH REQUEST <br /> AH EXTENSZOH. PRIOR TO THE EXPIRATION DATEOF THEPERHiT. iF CONSTRUCTION FAILS TO <br /> NEET ALL REQUZRENEHTS OF STATE LA~S AHD HARIOH CoUHTYDUZLDZHG AND ZONZHG ORDIHANCES~ <br />PL. ANNI~G <br /> 5ETDACKS." FR 11 <br /> LS""i~ <br /> RS""15 <br /> RR-'~O <br /> sPZ <br /> REMARKS: HFG HOME <br /> <br /> ~SNALD E~ ~OODLEY~ HARMON COUNTY DUZLDTNG O~DICIAL / BY ....... ~ .................................... <br /> <br /> OFFICE COPY <br />FORM '/MC '1~-~6 REV, 4/90 <br /> <br /> <br />