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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 <br />CODE-A-PHONE 4:30 P.M. - 8;00 A.M. <br /> <br />I am performing work on a property I own or occupy, <br />I am a registered builderOR( ) the authorized representative <br />of a registered builder, <br />The work will be performed by a registered builder· <br />OtEer, <br /> <br /> I have read and aQree to the terms stated on the reverse side of <br /> this document· <br />DATE: 05/11/88 TIME.' 9:16:31a <br /> <br />StCNATURE OF APPLICANTz <br /> <br />OWNER: PEARSON, <br /> <br /> 124.83 FRY ROAD <br /> <br />AURORA <br /> <br />DSE Of BUILDING; <br /> <br />MA~LING ADDRESS: <br /> <br /> SN~,IE <br /> <br /> PHONE: 678-255? <br /> <br />CATE: <br /> <br />40917-000 <br /> <br />CATEGORY: RESIDENTIAL <br /> <br /> NE <br />OR 9?002 <. CONTRACT CITY: } GGE~: :OCCUPANT LOAD: <br /> ~RION CXDUNTY ¢ NO <br /> I NO OF BEOROOMS <br /> 3 <br /> <br />LOT BLOCK: <br /> <br />TYPE: MOBILE HOME <br /> <br />CONTRACTOR, NO. <br />PEARSON, RON <br />SAME <br /> <br />PHONE: 678-2557 <br /> <br /> ITEM <br />MO~ILE HOME FIRST WIDTH <br />MOBILE HOME ADDTL. WIDTH <br />MO~ILE HOME ZONING SURCHAROE <br />FLEET .SURCHARGE -ZONE 6 <br />MOBILE HONE STATE EAJROHARGE <br /> <br />PAYEE: <br />RECEIVED BY: J8 <br /> <br />TOTAL A,SSESx.SED.FEES <br />'PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />BALANCE DUE <br /> <br /> TYPE: <br /> <br />QUANTITY AMOUNT <br />I $35.00 <br />1 $15.00 <br /> ~2.50 <br /> 7.68 <br /> $2.50 <br /> <br />~62.68 <br /> 62.68 <br /> $0.00 <br /> <br />$0.00 <br /> <br /> RECEIPT <br /> CHECK <br /> <br /> THIS IS A VALID PE~',IIT m THIS PEI~IlZ EXPIREI~ 180 DAY'S:FROM ITS I~E ~TE+ IF <br />~CTI~ C~ FOR A PERIOD OF '1'80 .'~,OR' IF ~T~I~ FAI~ TO MED ALL <br />REdIReCTS OF STATE ~ ~D~RI~ ~N~ BUILDIN~ '~D Z~ING ORDIN~C~, ~IS PE~IT <br />~ALL ~E~E NULL ~D ~ID. <br /> <br />REHARKS: REPLACE MO HOME R~8569 APPROVED FOR 1SZNG, FAM+RES+ONLY <br />PLANNING ACTION: <br /> <br />DONALD E. NOODLEY, HARION COUNTY BUILDING OFFICIAL / BY <br /> <br />F(.IF~M # MC 15-56 REV ~/~7 OFFICE COPY <br /> <br /> <br />