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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) 588-7904 <br /> <br /> I~HUFACTIJR[D OWELI.I~ APEIUTI2 <br />DATF/TI#F : B9/77/76 17=35 ~TIVITY NO = ~-I7695 <br />TY~ : Hew Hanufectured Dwetting STA~S = APPLIED <br />~C~Ai,,IC,¥ : R-3 APPLI~ = ~/27/19~ <br /> ~ EXPIRE = S3/2~1997 <br /> P/tGE 1 <br /> <br />W~RK ~F'~C = NMF~/W~N~FHFRF MFA~OW~ SP~7~ <br /> <br />9~T~ AOI)RE~B = CITY: AUHSVILLE ~4 A~gFY IN SF AM <br /> <br />P,~OSS STRFF. I' : H'[I.I. CRFEK <br /> <br />PA~(':FI NIIHRF'R ; <br /> PARCEl, S~F <br /> <br />OWNF~ NAMF : WORTHTN(;TON~BR~AN <br /> <br />APPLICANT <br />N~MF ~ RICK GOMF~ <br />A~RESS : 518 VALLEY WOOD OR SE <br /> SAI FM, OR <br /> <br />PHONF ; 7&?-7744 <br /> <br />,ONTRAL~OR/ ,ARVER ENTERPRISFS I.L.C <br />A(;FNT : R~CK <br />PHONE : 769-7744 <br /> <br />~[NS1 Al I FR : <br /> PHONF : <br /> <br />IIN~T SO FT <br /> <br />I ANI/ USE: <br /> <br />97.3~6 <br /> <br /> OCCB: 0098~40 <br />MD LICENSE: <br /> <br />J}nits 1)escription Fee <br /> <br /> l Stat~ surcharge 12.25 <br /> I State ~dmJn~s~v'at~ve f~e 28.00 <br /> <br /> Assessed fees : 277.25 <br /> AdjustM~nt*s : .00 <br /> Total fees : 277.25 <br /> PAYFF'; RTCK 6(1HFS Total payments: .08 <br /> Balanc~ dQe : 277.25 <br /> <br /> THIS IS 1~3T A PERMIT. THIS APPLICATIO# ~UST GO THROUGH A SIHULTP~IEOUS REVIEW <br /> PRO¢~S ~HFRF ZOH7H(;~ SEPTIC (IF ~PPtIC~tE) AHD SITE PL~H IS CHECKED PRIOR TO <br /> TH[ ISSUAHC, E ~F A PERMIT. IT TS THE. RE~O#ST~I!.ITY OF THE APPLICAHT TO ASSURE <br /> THAT AiL HF~FSSARY IHFORMATIOH IS PROVIDE~. AS ~OOM AS ALL REOUIREHEHTS OF THE <br /> R~VIE~ HAVE ~E[H HET~ Y~II ~ILL SE H~TTFIED THAT YOUR PERHIT HAS 9EEH ISSUED. <br /> ;T~N~TUEF OF' ~PP[]'CANT= .................................................... <br /> <br /> ~f~NAID F WOflD[FY~ MAR~ON COIINTY BIITIDTN(; OFFiCIAl / BY PRYON <br /> <br />..................................... FOR OFFICE USE ONLY ......................... <br /> S)TF / itl;~: AH F~ <br /> MAP: 7f)NE~ T PROPERTY I.OCATOR: 081W30 02~00 <br /> <br /> R~ !~FTBACI(!~Froof: ~0 l~f~: ~'ji R~ght: 15 Rear: 15 Special: <br /> <br /> PI.AN RFV'TKW : I)ATE: ZON[NG ~EVIEW: ])ATE: <br /> <br /> <br />