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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 /> ,,m er,orrn,n workona rd er~ ,o~o~CODE'A-PHONE:588'7904 <br /> ChfeSrw~gr~twei~eb;elrdfeor;meO by a re,lstereO builder· /// <br /> Other <br /> I have Cead and agree to the terms stated on the reverse side of DA~E: <br /> this document. <br /> <br /> DA'rE~ 04/28/9~ '~I~E; ~0~02:38 <br />OWNER; , TAX ~OT: <br /> LiFFL~DER C 5?6-65-000 <br /> <br /> 8851 ~i'rH RD <br /> AUM3V I LLE <br /> <br />USE OF BUILDING: <br /> <br />OR 97326 <br /> · MARION COUN'FY; NO <br /> <br />CATEGORY: <br /> <br />OCOdPANT LOAD: <br /> <br /> MAILING ADDRESS: IViANU FAG': U REB S t RtJCTU RE SUbmVlSiON: <br /> 3290 BALS~ OR S ~~ <br /> SAL~ OR 9?302 ~~ ~- <br /> PHIL: 363-~418 ~ ~~ SiTE NU~ER: 92-01640 <br />  VALUAT l~: <br />,LO~: ; TOWNSHIP'. RANGE; ZONE: <br /> <br />WIDTH: OEPTI4: AREA; , UNITS: iRR6G. LOT= : CORNER: <br /> AC NO ~ NO <br /> <br />2 <br /> <br />51 <br /> <br />'FYPE; MANUFACTURED STRUCTURE <br /> <br />(~I'RAC'FOR, NO. <br />LiFFLANDER C <br />3290 8ALSA~ OR S <br />5¢,LE~4 OR 9?302 <br />PHONE: 363-6418 <br /> <br />PER~41T OR APPLiCATiON NO: 9039638 <br /> <br /> ITEM <br />I~tANUFAC'ruRED SIIRL-[O'I'UR6 ZONING SURC..'HARC2,E <br />M UF'AC'rU E STRUCTURE <br /> <br />TOTAL ASSESSED FEES <br />PRE¥1OUS RECEIPTS <br />THIS RECEIPT <br /> <br />BALANCE DUE <br /> <br />PAYEE: LIFFLANOER C <br />RECEIVED BY: ~ ........................................................................ <br /> <br />TYPE.* CK <br /> <br />¢~,~AN')' t TY AC4OUNT <br /> ~15.00 <br /> 25.00 <br /> <br /> $40.00 <br /> $0.00 <br /> $40. OD <br /> <br /> $o.oo <br /> <br />RECEIPT 41r~81 <br />CHECK ~: 1169 <br /> <br />~ THI~ IS NOT A PER~IIT. THIS APPLICATION FUST GO THROU~I A REVI~ PROCEE~ I~'tERE THE FOLLOWiN <br />I~JST BE CO~IPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT ALL NECEI~ARY <br />INFORI~ATION HA~ BE~ Pi~)VIOF_D. <br /> <br />SEP'F IC: BY DATE, _ <br /> <br />ZONING: E <br />RF.,~ARKS: ............................................... .......... <br /> <br />CITY JURtS01C'FiON+~ BY DATE <br /> <br />PLANNING ACTION: <br /> <br /> OFFICE COPY <br />FORM ~ MO 15-~6 REV, 4/90 <br /> <br /> <br />