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MARION COUNTY BUILDING INSPECTION <br />SENATOR @LOG, 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 />Other <br /> <br />I have read and agree to the terms stated on the rever~e side of <br /> <br /> H~LL C~EEK EI~T~'FE:S <br /> <br />55 ~3 5%:L5~ NO NO <br /> <br />TypiC= HANUFACT~JRED STRUCTURE <br />CONTRA(:iTOR,~ HO,, 4907 <br /> KT, L.R~YS <br />:'23~ N PACIFZC FI~IY <br />WOODBURN~ <br />PHONE~ 981-8146 <br /> <br />~ANUFAC'FUI~ED ~'Fi:~UCTURE <br />HANUFACTLIR/~ mTRLJ~TURE, S- <br />MANUJ" A,,, lURED S~ RUC~ Jl~[ <br /> <br /> PAYEEI; Pel McCormick <br /> <br />FOLLDWING~UST BE <br />THAT ALL NECESSARY <br /> <br />PERHITOR APPLICATION NO: 9~5281~ <br /> <br />QUANTITY AHOUN'?' <br /> <br />$211.I8 <br /> $0.00 <br />$211.10 <br /> <br />$0.80 <br /> <br />,CHECK ,~ <br /> <br /> WHERE THE <br /> <br />SE'I'BACKS~ <br /> <br />; ~.,~ R~. 4~ OFFICE COPY <br /> <br /> <br />