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MARION COU~fl'Y B~UILDING INSPECTION <br />SEN'A~I-*.OR BLDG NO 225 <br />220,~41GH STREET NE <br /> SALEM, OREGON 97301 <br /> <br />PHONE:: 588-5147 8::00 - 4::30 <br />HOUR CODE-A-PHONE:: 588~7904 <br /> <br />I am performing work on a property I own or oCCug'y <br />I am a registered builder OR ! ) the authorized representative <br />of a fogistered bulldO( <br />The work wdl bo performed by a registered builder <br />Other. <br /> <br />SITUS <br /> <br />TAX LOT CATEGORY <br />CONSTRUCTION TYPE OCCUPANCY <br /> <br />OR -97325 <br /> <br /> CONTRACT CITY UGB OCCUPANT LOAD <br />AU~E, VILLE NO ~o oF EI(OR00MS <br /> <br /> 4305 GARY $'f' <br /> KEIT. ER. OR 9?303 <br /> PHONE: 390-2267 <br />LOT BLOCK <br /> <br />TOWNSHIP <br /> <br />SIIE NLJlVlBgR: 11514 <br />R,",,~LUAFION: ZONE MAI' <br /> <br />IRREG LOT CORNER <br /> NO .... NO <br /> <br />IYPE*. IviOfBtLE HOMg PERMIr OR APPLICATION NOt <br /> <br />ODNIRAC;TOR, NO. 14922 <br />O~TRAL OREGON IvIOBiLg <br />28.5 ~O.PNgiFIC HiGH~AY <br />NOODBURN, OREGON 97071 <br />PHONE: 983-2141 <br /> <br /> ItEM <br />i'~t.'~iLE HOME BA3E FEE <br />fvF...~ILE HONE 5f'Af'B FEE <br />FLEEr SURCHARGE -ZONE 3 <br />MOBILE HONIE 5fare SURCHAI:~3E <br /> <br />28445 <br /> <br />TOTAL A~EfJ~.%ED <br />PREV 1CUE. RECEi P 1,5 <br />THiS RgCEi P'I <br /> <br />QUAN|tTY <br /> <br />AJvfOUNl <br /> ~89.25 <br /> 15.75 <br /> $3.84 <br /> $5.25 <br /> <br />$1~.09 <br />$~14.o~ <br /> <br />BALANCE DUE $0,00 <br /> <br />PAYEE: iNVOICE <br />RECC;[VED BY: CL IYPE.' CHECK t~.: <br /> <br /> THIS IS A VALID PERI,lIT * THI8 PERNIT EXPIRE3~ 180 DAYS FflC~ IlS i,~3t. JE DATE. iF <br />~NS'I'~CTI~ C~ FOR A PER/OD OF 180 ~,OR iF ~T~CT[~ FAI~ TO MEE1 ALL <br />~QuiR~r5 oF $')'ATE ~ ~D ~RI~ ~N'~ ~UILDING ~D Z~iNG ORDiN~C~, THI~ PE~IT <br />~ALL BEdE NULL ~D <br /> <br />SBIBACK.%s FR 10 ~ 10 ~ 10 RR 10 SP <br />RE~'4AR~: MF.~BILE H(,)I'4E ...... <br /> <br />PLANNING ACilON: <br />Or. JNALD E. NOOOLEY, MARION OOLINIy BUILDING OFFICIAL / BY <br /> <br />FORM # MC ~d-66 REV 4t90 OF FICE COPY <br /> <br /> <br />