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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 /> <br />I am performing work on a property I own Or occupy. <br />I am a registered builder OA the authorized representatwe SIGNATURE OF APPLICANT: <br />of 8 registered builder, <br />The work wl,I be performod by a registered builder. <br />Other, <br />I I~ave read and agree to the terms stated on the reverse side of DATE: <br />this document· <br /> <br />OWNER: DATE: 09/08/93 TIME: 12,,/~0.o8 TAX LOT: :dAfE~RY: <br /> MCLAUGHL. AN~ ROBERT *~ ~ <br /> <br /> AUMSVZLLE OR 97325 . MARIOH COUNTY; NO <br /> use OF 8dmLomN~: ;NO 0¢ ~o~Oo~. <br /> <br /> SITE NUMBER: <br /> PHONE: 769-3124 VALUATION: <br /> <br />LOT: BLOCK; ~ECTiON; TOWNSHIP: , RANGE; : ZONE'. MAP; <br /> <br />TYPE: HAHUFACTUREI) STRUCTURE PERHIT OR ~PPLICATTON HO: <br />C9, NTRACTOR, NO. <br />MCI. ALJGI4LAN~ ROBERT <br />SAi4E <br /> <br />RHONE,'. 76~-5~24 <br /> <br /> I TE~ <br />~ANUFACTUREQ STRUCTURE PLACEMENT/COHNECTZON <br />~ANUFACTURE~ STRUCTURE STATE FEE <br />~ANUFACTUREB STRUCTURE STATE SURCHARGE <br />MANUFACTURED STRUCTURE ZONIN6 8UROHARCE <br /> <br /> TOTAL ASSESSES FEES <br /> PREVIOUS ~ECEIP~S <br /> THIS RECEIPT <br /> ' BALANCE SUE <br /> <br />QUANTITY AMOUNT <br /> $182.00 <br /> $28.00 <br /> $9,10 <br /> $15.00 <br /> <br />$228,10 <br /> $0.00 <br />$22~.10 <br /> <br />$0.00 <br /> <br />PAYEE: MCI.,.AUGIqLAN~ ROBERT : : RECEIPT 52080 <br />RECEIVED BY: C1 ................. .; ....... = ....... ~..__ T~p'E: CK CHECK ~: 13~1 <br />~ THIS IS NOT A PERMIT, THIS ~PPLICATION MUST ~0 ll4ROUGHAREVIEW PROCESS WHERE TRE <br />FOLLOWINB MUST BE COMPLETEI). : iT IS THE RESPONSIBILITY:OF THE APPLICANT TO ASSURE <br />THAT ALL NECESSARY iNFORMATIOHRAS BEENPRO¥IDED. <br /> <br /> PLANNZNE. ACTION: ,~_.iF <br /> PLAN REV~FW: BY SETBACKS: PR <br /> ZONING: BY ~ ................ DATE"Tt~'~'%~ .... LS--7~ <br /> RS-T~ <br /> CITY JURISDICTZOH: BY DATE SF .... <br /> REMARKS: ,~s/ss/se/ <br /> <br />FO~M ~ MO la-56 REV, 4~ <br /> <br /> <br />