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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 /> I I am ~ registered builder OR( ) the authorized representative SGNATUR~ OF APPLICANT: .......... <br /> <br /> The work will be performed by a registered builder, <br /> Other_ <br /> <br /> DATE: 09/28/92 TINE: 12:48:08 <br /> <br /> ~ : <br />:~l~S ADD~Ess~ ~ CONSTRUCTION TYP~: I OOCU~ANCY: <br /> <br /> ~80 EVERGREEN OR 8 <br /> ~ ~5~" ~ ~: OCCUPANT LOAO; <br />: AUHSVILLE OR 97~25 <br /> <br /> i EVERGREEN ESTATES HH P~RK <br /> S~HE <br /> ~ SITE NUHBER: ~2-05255 <br /> PHONE: 399~78~0 ~ V~LU~TION: <br /> <br />LOT B~OCK: ~SECT ON ,TOWNSH P RANGE . ZONE ~ MAP: <br /> 8 ~ ~ 25 <br /> <br /> 55 85 4675. <br /> <br />TYPE: MANUFACTURED STRUCTURE <br />CONTRACTOR, NO. ~82~8 <br /> Santiam Homes <br />11373 Mill Creek Rd <br />Aumsville, 9752S-0000 <br />PHONE: 769-7744 <br /> <br />PERflIT OR APPLICATION NO: 42521 <br /> <br />ITEM ' <br />NANUFACTUREO STRUCTURE PLACEMENT/CONNECTION <br />MANUFACTURED STRUCTURE STATE FEE <br />NANUFACTUREO STRUCTURE STATE SURCHARGE <br /> <br />PAYEE: <br /> <br /> TOTAL ASSESSED FEES <br /> ;: : THIS RECEIPT <br />: :"::: [ :LANCE-DUE <br /> <br />QUANTITY <br /> <br />INVOICE <br /> <br />AMOUNT <br /> $182.00 <br /> $20.00 <br /> $9.10 <br /> <br />$211.10 <br />$211.10 <br /> $o.oo <br /> <br />$0.00 <br /> <br /> ** THIS IS A VALID PERMIT; I*:::~THIS':PERMIT FEE COVERS oNE INSPECTION AND ONE <br /> REINSPECTION. ALL PLUMBING,:: HECHANICAL, AMD ELECTRICAL <br />CONNECTIONS ARE REQUIRED : ]TO BE COMPLETED: UPON;:RE~UE~:::EOR .~HE FIRST INSPECTION IF <br />ANY OF THE iTEMS ARE INCOMPEETE~ INSPECT~oN:]~E:E WILL BE REQUIRED~ <br />PERMIT IS VALID FOR SIX HONTH$ ONLY:. RENENED;.EOR.:6 MONTHS: UPON WRITTEN REQUEST FOR <br />AN EXTENSION. PRIOR TO THE EXPIR~T:ION::DATE OF.:!FHE::PEEMIT~:: ~F CONSTRUCTION F~IL$ TO <br />MEET ALL REQUIREMENTS OF STATE: LA#S ~NO HARI:ON'COUNTY'BUI.LD[NG AND ZONIN6 ORDINANCES, <br />PLANNING ACTION: <br /> ,:' , : ~ SETSAC~S: <br /> : F~ <br /> R3~15 <br /> RR 10 <br /> sPZ <br /> RENARKS: NOBILE NOME PLACENENT <br /> <br />DONALD E. WOOOLEY, MARION COUNTY BUILDING OFFICIAL / BY .... ~ ......................... <br /> <br /> OFFICE COPY <br />FORM # MC 16-56 REV. 4/90 <br /> <br /> <br />