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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97'301 <br /> <br /> PHONE: 588-5147 8:00 - 4;80 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am performing work on a oroperty I (own or occupy. <br />lam aregistered builder OR( )theauthofizedrepresentative <br />of a re¢ istorod builder, <br />The work will be perforn)od by a registered builder. <br /> <br /> i have read and agroo to Ihe terms Stated on the reverse side of <br /> this document. <br /> <br /> DATE: 10107193 TINE: 8:~7:01 <br />OWN~R~ SANTIAM HOMES <br /> <br />SIGNATURE OF APPLICANT: <br /> <br />TAX LOT; : o~,~p~ENT iAL <br /> OCCUPANCY: <br /> <br /> 211 BELLEVUE DR -- <br />AUMSVILLE OR 97325 <br /> <br />' <br />' ~IEE~ u~ OCCUPS.T Lo^o: <br /> <br />vs~ o~ gu~Lm~iqUFACTURED STRUCTURE <br /> <br />~i[,iN~ADOA~S~ SUBDV$ON: <br /> MILL CREEK ES'rATE9 <br /> AGENT:CRAIG LUCAS <br /> SITE NUHBER: ?~-~3474 <br /> PHONE: 769-7744 VALUATION: <br /> <br /> 81 <br /> <br />;WIDTH: 84 ;D~PTH; 55 AREA: 4628. iUNIT~F i IR%~, LOT; COllie; <br /> <br />TYPE: HAHUFACTURED STRUCTURE <br />CONTRACTOR~ NO. 382~8 <br />Daniel L Cerver <br />].1~7~ Hill Creek Rd <br />Aunsville~ 97~25-0000 <br />PHONE: 769-7744 <br /> <br />PERMIT OR APPLICATION NO: 9~58472 <br /> <br /> ITEM <br />MANUFACTURED STRUCTURE PLACENENT/CONNECTIgN <br />MANUFACTURED STRUCTURE STATE FEE <br />MANUFACTURED STRUCTURESTATE SURCHARGE <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY <br /> <br />AMOUNT <br /> $182.00 <br /> $20.00 <br /> <br />$211.18 <br /> $0.00 <br />$2:L].,,10 <br /> <br /> , ~ BALANCE DUE , $0.00 <br />PAYEE: Del McCormick kh~ , INVOICE 52887 <br />RECEIVED BY: DM2 ..k_./ ' TYPE: IN CHECK ~: <br /> .................. ~=~===:~:~=====~== ................................ <br />* THIS IS NOT A PERHIT. THIS APPLICATiDH MUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING HUST BE COMPLETE~. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE <br />THAT ALL NECESSARY IHFORHATiDR HAS BEEN PROVIDED. <br /> <br />PLANNING ACTION: <br />PLAN REVIEW: BY_._~;;~c~:_ .... DATE (O%]~_~_c~'~' <br />ZONING: BY DATE ....... <br /> <br /> CITY JURISDICTION: BY ........... DATE ......... <br /> REMARKS: MS <br /> <br />SETBACKS: <br /> <br />FR 11 <br /> <br />RS-15 <br />ER-10 <br /> <br />OFFICE COPY <br /> <br /> <br />