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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 9'7301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />The work will be performed by a registered builder. <br />Other. <br /> <br /> I have read and agree to the term~ stated on the reverse side of <br /> this document. <br /> <br /> 9ALE: 04/25/92 liME: 9:38:31 <br />OWNER: <br /> GREEN, JOE <br />SITUS ADORESS; <br /> <br />SIGNATURE OF APPLrCANT~ <br /> DATE' <br /> <br />CATEGOR~ <br /> <br />OCCUPANC~ <br /> <br />RES ] DEN T' I <br /> <br /> 11684, LARK COURT <br /> AURORA OR 9?002 <br /> <br />10SE OF aU~'CT~i <br /> <br />CONTRACT CITY UGS <br />M, ARZON C(IJN I Y NE) <br /> <br />MAILIN~ ADORESSi MANU FAC'lURED S:f: RLIOTU RE <br /> <br />20 WALKING ~OOD OR <br />LAKE OEA4EGO, OR <br />PHONE: 535-7918 <br /> <br />LOT; ' BLOCK: :SECTION[ <br /> 85 85 <br /> <br />SUBDIVISION <br /> <br />CENTURY MEAOOIA[5 NO - <br /> <br /> [5 i'T'E NUMBER: <br /> VALUA i iON: <br /> <br />5525. ,%_'F NE) NO <br /> <br />MAP <br /> <br />3 <br /> <br />TYPE: MANUFACTURED S'f'RUC'fURE <br /> <br />CONTRACt'OR, NO. ?39?7 <br /> LAMAiN CONS'f'RUC'f'ION <br />205 SE 4,'f'H <br />fROUTOALE, 9?080-0000 <br />PHONE: <br /> <br />PERMIT OR APPLICATION NO: 39540 <br /> <br /> iTEM <br />~ANUFAC'f'URED STRUCTURE PLACP:J~EN'f'/CONNECTION <br />IV',ANUFACTURED [5'f'RUC'f'URE STATE FEE <br />MANUFACTURED S'FRUC'rURE STATE SURCHARGE <br />fv~ANUFAC'I'URED SI'RUC'f'URE ZONING SURCHARGE <br /> <br />'f'O'f'AL A~EDFEES <br />PREVIOUS RECEIPTS <br />THiS RECEIPT <br /> <br />(~UAN'T'i'I'Y AMOUNI' <br /> $182.00 <br /> $20,00 <br /> <br /> $15,90 <br /> <br />$226, '10 <br />$2;.25.30 <br /> $0,00 <br /> <br />BALANCE <br /> <br />PAYEE <br /> <br /> RECEIVED BY; OM2 TYPE; CHECK ~: 0 <br /> <br />*~ THIS IS A VALID PER~qlT :** THiS PER~IT FEE COVERS ONE iNSPECTION AND ONE REINSPF.:CTION. ALL <br />8LOCKZNG, STAIR INSTALLATION, PLUlV~ING, MECHANICAL, AND ELECTRICAL CONNECTIONS ARE REQUIRED l' <br />8E COIe1PLETED UPON REQUEST FOR THE FIRST INSPECTiON. IF ANY OF THE I'I'EI~5 ARE INCOi~PLETE, AN. <br />ADDiTiONAL INSPECTiON FEE HiLL BE REqUiRED. PEF~4IT iS VALID FOR SIX ~THS ONLY. RENEWED FOR <br />5 MONTHS UPON WRITTEN REQUEST FOR AN ED(TENSION, PRIOR TO THE EXPiRATiON DATE OF THE PEr.lIT. <br />iF CONSTRUCTION PAILS TO ~EET ALL REQUIRIE4ENTS OF STATE LAt~/S AND M&RioN COJNTY BUILDING AND <br />ZONING ORDINANCES. THIS PE~iT SHALL BECO~IE NULL AND VOID. <br /> <br />5EI'BACKS: FR 10~o'"" 5 R5 5 RR ~2 <br />REMARKS: MFG"HOME .................... <br /> <br />PL_ANNING ,~.C f J:ON; <br />OONALD E. ~,*)OODLEY, MARION COUNTY BUiLDiNG E)FFICiAL / BY <br /> <br />FORM # MC 15.56 REV. 4/~ <br /> <br />OFFICE COPY <br /> <br /> <br />