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MAHIf}N (Df}UN I Y I:$UILIJlN~ IN~P'I-L;I IUN <br />SENATOR BLDG· NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-$147 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> I am pertorming work on a property I own or o¢¢ py <br /> I am a reglstored builder OR the authorized represef3 avO <br /> of a regis Bred bu der. <br /> The work will be pedOrmed by a registered builder. <br /> Other ....... <br /> I have read and agree to ~he terms stated on the reverse side St <br /> this document. <br /> <br /> OA'[~: 01/~0/9~ TIME: 9;5?:26 <br />OWNER; i TAX LOT; <br /> RA88, JOSEPH I <br /> <br />SIGNATURE OF APPLICANT: <br /> <br />DATE: <br /> <br />{ ~iT(JS ABORESS: i CONSTRLJO:fI'~)'~ ~vP~: ! OCCUPANCY; <br /> <br /> DETROIT OR 9?342 <br /> .......... ~ET~On' i _ No_ _ <br /> USE OF BUILDING; '~NO 6r B~6n66MS <br /> <br /> f4ANUFACIURED ISTRUC'FURE ~ 2: <br /> <br />3103 288 'IAKE~HORE RD <br />BCiJLOER CITY NV 89005 <br />PHONE: 702-293-6~80 <br /> <br />.... ISAfA~ORY: <br /> 678-0198 i RE~iDEN11AI <br /> <br />;LOT: <br /> <br /> SITE NUiYIS£R: 92-00252 VALUAT I ON t <br /> <br /> 4;DEPTH: ............................. i AREA: I UNITS; ~ 16R~G. COT': ........ <br />80i 80, e4oo. ~ SF~ NO ~ NO <br /> <br />T'YPE: I"&ANUFACTURED ~I'FI'IJCI'URE PERIvI,i1' OR APPLICATION NO: 3'7853 <br /> <br />CON'[RACTOR, NO. <br />RABB, JOSEPH <br />~103 268 "IAKESHORE RD <br />BOULDER CITY NV 89005 <br />PHONE: 702-293-6480 <br /> <br />MANUFACTURED STRUCTURE PLACEI~ENT/C;ONNECTiON <br />~tJFAC'f'URED SI'~CI'UR6 8TAl'E FEE <br />~UFAC'f'UREO ST~C'FURE S'FA'FE ~A~ <br /> <br />PAYEE: . <br />RECEtVEO BY: ~2 ,.:,-,:~y~6:' <br /> <br />QUANTITY Af~E.~JN1 <br /> $182.00 <br /> $20.00 <br /> $9.~0 <br /> <br />$21,1.10 <br />$2~1.10 <br /> $o_oo <br /> <br />$0.00 <br /> <br />iNVOICE <br />CHECK ~: 0 <br /> <br /> THiS <br />[ELOCc~JlNp.6~,__~IAIR iNSTALLATION,? PLU.I~_!INS;ii'~ECI-IANICA,E.:,,~'~,~O?L_EUEOTRiCAL CONNECTIONS ARE <br />........ ~ .,,~r~..~. rc~ SiX INIONTHI~ ONLY. RENEWI~D FOi <br /> <br />SE'FBACK~: FR 20 LS 5 R~ 5. RR 5. SP <br />REt%'ARKS:PLANNiNG AC'FIQN:REPEACEMENT MP'G :'" ~:; ........ i;':'il ~ <br />CONALO E_ INOOOLE~, ['4ARiON:Cr..I~NT¥'BUiLO.ING:':OPFiC1A~:./'B¥~,;::,'.!':,:,, <br /> <br />OFFICE COPY <br /> <br /> <br />