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MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> <br /> 285 Chumh Street NE · Room 132 ° Salem, Oregon 97301-3670 <br /> Office Hours: 8:00-4:30 · Phone: (503) 5885147 · 24-HR Inapeetlon Line: (503) 373-4427 <br /> <br /> MANUFACTURED D#ELLING APPLICATION <br /> = B6/17/96 ~15:54 ACTIVITY HO = 76-B4388 <br /> Hem Hanufactured Dwel/tng STATUS = ~PPLIED <br /> : R-3 APPLIED : B6/17/1996 <br /> TO EXPIRE : 12/14/1996 <br /> PAGE 1 <br /> <br />WORK DESC : NEW MD <br /> <br />SITE ADDRESS : CITY: MARION COUNTY ~75 MIX RD SE AM <br /> <br />CROSS STREET <br />PARCEL NUMBER <br />PARCEL SIZE <br />OWNER NAM~ <br />APPLICANT <br /> NAME <br /> ADDRESS <br /> <br /> PHONE <br /> <br /> CONTRACTOR/ <br /> AGENT <br /> PHONE <br /> <br />;~ NSI'ALLER <br />PHONE <br /> <br />UNIT SQFT <br /> <br /> IJni;:s <br /> <br /> 1 <br /> <br />PO?~¥R RD SE <br /> <br />6047t-000 <br /> 2~AC <br /> <br />MIX, WESlEY & E~STF i. <br /> <br />MIX,JEROL~) <br />4778 JONES RD SE <br />SA[EM <br />OR <br /> <br />97302 <br /> <br />: O(,CB. <br /> MD LICENSE: <br /> <br />Des~r io't:i, on <br /> '~-;',"~'~'~ctur ed""'dwe.I 1 lng <br /> ,~tate surqharge <br /> Stat~ administrative fee <br /> Zoo~ surcharge <br /> <br />Fee <br /> <br /> 12.25 <br /> 20.88 <br /> 20.00 <br /> <br /> Assessed fees : 2~7.25 <br /> Adjustments : .00 <br /> Total fees : 2~7.25 <br /> PAYEE: MIX~JEROLD Total payments: 2~7.25 <br /> B~]ance due : <br /> <br /> THIS IS NOT A PERMIT. THIS APPLICATION HUST gO THROUGH A SIHULTAHEOUS REVIEW <br /> PROCESS ~HERE ZOMIHG, SEPTIC (IF APPLICABLE) AH]) SITE PLAH IS CHECKED PRIOR TO <br /> THE ISSUANCE OF A PERMIT. IT IS THE RESPOHSIBILITY OF THE APPLICANT TO ASSURE <br /> THAT ALL NECESSARY IHFORHATION IS PROVIDED. AS SOON AS ALL REOUIREHEHTS OF THE <br /> REVIE# HAVE ~EEN HET; YOU UILL 8E NOTIFIED THAT YOUR PERMIT HAS BEEN ISSUED. <br /> SiGNATUREOFAPFLiCAflT:~~.,.,/_IC*'___~~ ~ <br /> OONAI.D E WOODLEY, MAR'[ON-'COHNTY BUILDING OFFICIAL / BY MBULL. <br /> <br />...................................... FOR OFFICE USE ONLY ................................ <br /> SITE / UGB: <br /> MAR: dO ZONE: EFU PROPERTY LOCATOE: M?~rW05 81188 <br /> <br /> REQD SETBACKS:Front: ~9~ Left: ~9~ Right: ~ Rear: ~ Special: <br /> <br /> PLAN R!~VIEW : DATE: ZONING REVIEW: DATE: <br /> <br /> <br />