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MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> <br /> 285 Church Street NE · Room 132 * Salem, Oregon 97301-3670 <br />Office Hours: 8:00-4:30 · Phone: (503) 588-5147 · 24-HR Inspection Line: (503) 373-4427 <br /> <br /> MAHUFACTURED DWELLING APPLIC~TIOH <br />DATE/TINE : B9/17/76 12:81 ACTIVITY HO = 96-87329 <br />TYPE : Hem Hanufactured O~elIing STATUS : APPLIED <br />OCCUPANCY : R-3 APPLIED = 89/17/1996 <br /> TO EXPIRE : 83/16/1997 <br /> PAGE 1 <br /> <br />WORK DESC : MFQ HSME REPLACEMENT <br /> <br />SITE ADDRESS = CITY: AUMS¥ILLE 210 KLEIN ST AM <br /> <br />CROSS STR.ET SHAW MY <br />FARCEL Nt~MBER : ,~6, 0.L-00~ <br /> <br />PARCEl,, SIZE <br />OWNER NANI/ <br /> <br />APPI.ICANT <br /> NAME <br /> ADDRESS <br /> <br /> PHONE <br /> <br />C ON T RACTC*'i.~'/ <br /> AG.~'NI' <br /> PHONE <br /> <br />INS'TAt LEA <br />PHON~ <br /> <br />~ 49~ OSF <br /> <br />: ~AF;RIQUEZ~FIDELA & NSE <br /> <br />: ROEHM JOHN A <br />.", 17277 S FERNWOOD <br /> <br /> MSLAL LA~ OR <br />: 829-4871 <br /> <br />: ROEHM JOHN A <br />: ROEHM JOHN A <br /> <br />97038 <br /> <br />LAND ~JSE: <br /> <br /> OCCB: 8,896335 <br />MD LICENSE. <br /> <br />IINTT SQ FT : <br /> <br />Units l~esc~' .:~t ion F'ee <br /> <br /> I St,~te surcharqe 12.25 <br /> 1 State ad;,~:Lnis~rative fee 28.~8 <br /> <br /> Assessed fees 277.25 <br /> Adjus'~ men'~s .08 <br /> Total fens 277.25 <br /> PAYEE: ,,,f~ ,iOHN A Total payments: .08 <br /> Balance due : 277.25 <br /> <br /> THIS IS NOT A PER~IT. THIS APPLICATION ~UgT GQ ~ROUGH A gIMULTANEOUg REVIEW <br /> PROCEg5 WHERE ZOHIHG, ~PTIC (IF APPLICABLE) AHD SITE PLRH IS CHECKEO PRIOR TO <br /> THE ISSUANCE OF A PER~IT. IT I5 THE RESPgNS[BILITY OF THE APPLICAHT TO AggURE <br /> THAT ALL HECESSARY IHFOR~ATIOH l~ PRgVIOEO. A5 ~ON A~ ALL REQUIRE~EHT5 OF THE <br /> REVIEW HAVE ~EH ~El', YQU ~[LL BE ~OTIFIEO THAT YOUR PER~IT HAg BEEN [ggUEO. <br /> <br /> SIGNATURE OF APPLICANT: <br /> <br />D~}NAID E WOODLEY~ MARION COUNTY BUILDING OFFICIAL. / BY F'HUNRO <br />..................................................... FOR OFFICE USE ONLY ............................... <br /> <br /> MAF'~ ',;1 ~{~I,H~,~: Cf: PROPER'fY LOCATOR: ~81W3~C 885~ <br /> <br /> ;?q~O SETBA~iK~'*.~F~'ont:: J(~ L~.,ft: iff Right:: 15 Rear: 15 Special: <br /> <br /> FLAW REV'~EW : ~)AI'!~L: Z~'i,',IW(~ REVIEY: DA'IE: <br /> <br /> <br />