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( <br /> <br /> DATE: 04/17/87 <br /> <br />MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97;301 <br /> <br />I em a registered builder OR the aUthorized representa!ive <br />of a registered builder, <br /> <br /> PHONE ~88-5147 <br />CODE-A-PHONE 4:30 P.M. - 8;00 A.M. <br /> <br />I have read and agree to the terms Bteted on the reverse side of <br />this documer~t. <br /> TIME: 2:99:10p <br /> <br />OWNER: THOMPSON, DAVID <br /> <br />TAX LOT: 56362-006 QAT~GORY: R <br /> <br /> 8501 HOLFIQUIST ROAD SE <br />AU~ISVI LLE OR 97325 CONTRACT <br /> <br />~ BOX 182 <br />STAYTON, ORE~ 97383 ........ ~1~ ' <br /> <br />LOT: BLOCK: SE ' YOWh'SHIP ~ANGE; <br /> 31 8S ~ N <br /> <br />W~DTH DEPTH' AREA: 1 . 50000 UNITS: AO IRREG. LOT <br /> <br />SITE NLINSER: <br /> VALUATION: <br /> <br />UGB <br /> <br />OCCUPANCY: <br /> <br />OCCUPANT LOAD: <br /> <br /> 3 <br /> <br /> 1120 <br /> <br />ZONE MAP <br /> AR 49 <br /> <br />CORNER N <br /> <br />TYPEt IvlOBILE HONE <br />CONTRACTOR, NO. <br /> <br />PERHIT OR APPLICATION NO: 9001682 <br /> <br />PHONE: <br /> <br /> I TEN <br />MOBILE HONE FIRST WIDTH <br />lYE)BILE HONE ADDTL. WIDTH <br />fqOSILE HONE ZONING SURCHARGE <br />FLEET SURCHARGE -ZONE 3 <br />r4OSILE HONE STATE SURCHARGE <br /> <br />PAYEE: THCe~P~, DAVID <br />RECEIVED BY: dm <br /> <br />~ THIS IS NOT A PEFtI~IIT. THIS APPL] <br />FOLLOWING MUST BE COf4PLETED. IT <br />ALL NEC~RY INFORtflATION HAS <br /> <br />PLAN REVIEW: <br /> <br />SEPTIC: BY <br /> <br />ZONING: <br /> 8 T ~-J_~m~b DATE : <br />REMARKS: [~S~JBL~ WIDE MOBILE;HOME:, <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />BALANCE DUE <br /> <br />QUANTITY AMOUNT <br />1 $35.00 <br />1 $15.00 <br /> 2.50 <br /> 3.84 <br /> 2.00 <br /> <br />$58.34 <br /> $0.00 <br />$58.34 <br /> <br />$0.00 <br /> <br />INVOICE NO: 2t51 <br />TYPE: CK CHECK ~: 1116 <br /> <br />A REVIB PEOC~¥/rtERE THE <br /> THE APPLICANT TO ASSURE THAT <br /> <br />I: BY ........ DATE ......... <br /> R~-yj~( R R'- ~.~. <br /> <br />OFFICE COPY <br /> <br /> <br />