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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />S]GNATUF~E OF APPUCANT; <br /> DATE: <br /> <br />°WNI~M'E: 11/:2/91 TIME: 12;44'-4t <br /> <br />sgfus ADDRESE'DI'f"FMAN, JERRY <br /> <br />TAX LOT: CATEGORY: <br />CONSTRUCTION TYPE: OCCUPANCY: <br /> <br />RESiDEN~iA <br /> <br /> ~45 YEN C'f' <br />uSE ~:J~L~E eR-9?325 <br /> <br />SINGLE FAMILY <br /> <br />2??5 CLAX'f'ER RD NE <br /> <br /> PHONE: <br />LOI: BLOCK: SECTION: TOWNSHIP: <br /> <br />31 <br /> <br /> AUNFLSV i L, LE <br /> <br />SUBDIVISION: <br /> <br />UGB: : OCCUPANT LOAD: <br /> <br />NO <br /> <br />EVERGREEN ~H PARK <br /> <br />NO OF BEDROOMS <br /> <br /> 4 <br /> <br />SITE NUI~ER; <br />R^Ne~ALUA[ ION; ZONE; MAP: <br /> <br />CORNER: <br /> <br />f'YPE: MANUFACTURED STRUCTURE PEP.~I'F OR APPLICATION NO: 9036?43 <br /> <br />C(~N:RAC~OR, NO_ 14922 <br /> ~4 Noodburn <br />2~15 S P~cff~ic <br />Noodbunn, 97071-0000 <br />PHONE; 981-~141 <br /> <br />~UPACI'URED S'T',~'IJCTURE PLACEMEN'T'/CONNECTION <br />~ANUFAC'fURED STRUCTURE STATE FE~ <br />Iv~NUFAC'IU~ED S'¥RUC'f'URE 5EAYE SUk%~ARGE <br /> <br />'TOTAL ~ESSED FEES <br />PRC~IOU8 RECEIPTS <br />THiS:RECE~P'T' <br /> <br />BALANCE DUE <br /> <br />PAYEE= O01VlH <br /> <br />OUAN'rt'r¥ Ar~UN'r <br /> $:82_00 <br /> $20.oo <br /> <br /> $0.00 <br />$2~'~.'~o <br /> <br />$0,00 <br /> <br />iNVOiCE 385?3 <br /> <br />RECEIVED BY: CL ................................................................................................................ TYPE: iN CHECK ~: 0 <br /> <br />~ THIS I$ NOT A PERt. lIT. THIS APPLICATION MUST GO THROUGH A REViB PROCEC~ ~ER£ Trig FOLLOWlN( <br />CO~PL~T~D. IT i5 THE, RESPONSIBILITY OF THE APPLICANT, TO A,S~URE THAT ALL NECE~RY <br /> <br />~EP'f'iC: ~Y DATE CITY JURiSDIC'FI~: BY OA'IE <br /> <br />ZONING: BY DATE SETBACKS: PR LS RS RR <br />R~J~ARKS: <br /> <br />PLANN J. NG AC'T' i ON: <br /> <br />OFFICE COPY <br /> <br /> <br />