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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 />of a registered builder-
<br />The work will be performed by a registered builder,
<br />
<br /> MANUFACTURED STRUCTURE
<br />
<br /> SAHE
<br /> SiTE NU~BER: 93-~3676
<br /> PHONE: 74~-"37~]9 VALUATION:
<br />
<br />LOT,. ~w~ ~ ~8fiC'~'~ ~5~'~i~l ......... %il~'EF
<br />~ ~+~ - - -$~Y~ ..... m'x~- ...... 0~-r~:~ ~ 17N~. LOT:
<br />
<br />TYPE: MANUFACTURED STRUCTURE
<br />COI~TRACTOR,, Fl[I,, .20799
<br /> M{.MII,iI,tVi[I...[.E FACTOI:,,.Y HOMF_':S
<br />2058 S HWY 99 W
<br />HCM I NN¥:r.I,_LE,¢ ~7128.-.000~
<br />P. [ONF_'., 96?
<br />
<br />PERMIT OR APPLICATION NO: 50849
<br />
<br /> II'E;H
<br />M~NUFACTURFI) ;,1 RUC1 URE ~ L 4C~,,HEN f/CONNEC~ ION
<br />MANUFACI'UREI) ST~UCTURE. STATE FEE
<br />HANUFAC'rURED S'?RUCTUI"',E STATE: S~RCFIARGE
<br />MANUFACTURED STRUCTUFdE ZONING SURCHARGE
<br />
<br />TOTAL A,~oESSE. D FEES
<br />PREVIOUS RECEIPTS
<br />TFIS RECF]:PT
<br />
<br />BALANCE 'DUE
<br />
<br />[&JAN'f Z TY AMOtJNT
<br /> $182.
<br />
<br /> $;L5.,
<br />
<br />$0.00
<br />
<br /> P A Y E i"_';: R E C E '[ P T
<br /> RE'[]EIVE;O BY: cl. . ................................................... TYPE: CHECK -,f-: ~
<br /> $$ THIS IS A VALID PERMIT ~$ THIS PERMIT FEE COVERS ONE INSPECTION AND ONE
<br /> REZNSPECTION. ALL ~LOCKI~ ,STAIR I~STALLATIOH. PLUMBING, MECHANICAL. AND ELECTRICAL
<br /> ~8N~ECTIONS ARE REQUIRE9,TO BE COMPLETED UPON ,REQUEST FOR' THE FIRST INSPECTION. IF
<br /> ANY OF THE ITEMS ARE INCOMPLETE. AN A~ITIONAL 'IN~TION FEE WILL BE REQUIRER.
<br /> PERMIT IS VALIB FOR SIX MONT~ ONLY. ~ENEWE~ FOR 6 ~ONT~S UPON WRITTEN REQUEST FOR
<br /> AN EXtENSiON, PRIOR ~O THE EXPIRATIO~ ~ATE OF T~E. PERMIT. IF CONSTRUCTION FAILS T~
<br /> MEET ALL REQUIREMENTS OF STATE LA~S AND ~A~ION ~OUNT~ BUI,LBING AWE ZONING ORdiNANCeS,
<br />PLAHNIN~ ACTION:
<br /> ,~L I~ACk,~,, F'R.._2~
<br /> LS :~.~
<br /> R S.'... :1. ¢ (4
<br /> RR ,k~
<br /> ~ ~ .... : ~ ,. . , *_ :. .~ . ~ ~ ~ SP'; ...........
<br /> FUL~tAI'~KS~ MS/...~,,AU,,I L),, OK,~Y TO REPLAC. E 2 ~)R W,~,T~ NLW 3 BR HH,, IlJlJ
<br /> .,)(.HW,,,I) E,, WJC,*.L,:.,Y,~ H'~,,..ON COwhtN BUIL~.N60F'FICtAL / BY ................................................................................
<br />
<br />FORM # MC 15.,56 REV. 4/90 OFFICE COPY
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