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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: 58S-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE'. 588-7904 <br /> <br />J am serforming work On a proDerty I own Or OCCUpy, <br />~ am a registered builder OR ( ) the r~uthorlzed reDresentative <br /> <br />~-m~fO-~ ×~ ~';' ~- ...................................................... ~ '~ 5~ ~T~ib~Ai' TY¥~i .............................. ~ ¥0 D~-~%. ................... <br /> 9~04 GOLF CLUB RD SE j~c~ ..... ]~'O'~T ................ ~-~b-Ab; .......... <br /> AU~S~LLE ' OR 97325 ~ARION COUNTY/ <br /> <br />MAILING A~DRESS [SUBDIVISION: <br /> <br />SITE NUMB£R: <br />VAI. UATION: <br /> <br />'~Fi~ ........... <br /> ...................... <br /> <br />TYPE: MANUFACTURED OTRUCTURE PERMIT OR APPLICATION NO: <br />COIIfRACTOR~ NO. <br />FUSON, DESNOND & EVELYN <br /> <br />51616 <br /> <br />PI-lONE." 749-2~&8 <br /> <br />I TI""M <br />MANUFACTURED STRUCTURE F'~ACEMENT/ <br />MANUFACTURED ~TP, UCTURE FEE <br />MANUFACTORED STRUCTURE <br />HANIJFA~TURED STRUCTURE <br /> <br />RECEIVED BY: CL <br /> <br />~ THIO ES A VALID <br />REiHSPECTION. 'ALL <br />CONNECTIONS ARE: REOUI~ <br />ANY OF THE ITEMS ARE <br />PERMIT IS VALID FOR <br />AN EXTENSION. PRIOR' <br />MEET ALL REOOIREHENT$ <br /> <br />QUANTITY AMOUNT <br /> $182.00 <br /> $20,,00 <br /> <br /> $J. 5.00 <br /> <br />RECEIPT <br />CHECK ¢: <br /> <br />:CTIOfl AMD ONE <br />M[CHANICAL, AND ELECTRICAL <br /> FIRST iNSPECTION. IF <br /> ~ WILL BE REQUIRED. <br /> REQUEST FOR <br /> FALLS TO <br /> AND ZONING ORDINANCES, <br /> <br />SEI'BACKS~ FR 20 <br /> L,S-5 <br /> RS'-5 <br /> <br />roR~* ~c ~s.~,~v, ~ OF FICE COPY <br /> <br /> <br />