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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 am pe¢¢0rming work on a property I own or occupy. <br />Lamaregis~eredbullderOR( )theauthorizedrepresentat~ve <br />of a regbferedo' builder, <br />The work will be performed by a registered builder. <br />Other <br /> <br />[ have read and agree to the terms stated on the fevorse side of <br />this document. <br /> <br /> 0ATE= J, 0/21/92 TZME: .1_5:48:29 <br /> <br /> NE <br />OR 97002 <br /> <br />OWNER; <br /> GREEN, <br /> <br /> 11677 FALCON CT <br />AURORA <br /> <br />MANUFACTURED STRUCTURE <br /> <br />P0 BOX 759 <br />PORTLAND 97207 <br />PHONE: 685-9685 <br /> <br />SIGNATURE OF APPLICANT: <br /> <br /> CATE; <br /> <br /> TAX LOT~ <br /> <br />60~S~RUCTiON tYPE: <br /> <br />)§bs01VlsidN: <br /> CENTURY MEAOOOS ~4 <br /> <br /> SITE NUMBER; 92-03733 <br /> VALUATION: <br /> <br />CATEGORYz <br /> RESIDENTIAL <br /> <br />OCCUPANCY; <br /> R-5 <br />OCCUPANT LOAD: <br /> <br />k0 OF BED~Ob~4S: <br /> <br />'Lbf: eLodz: SECTION:' fOWNSAh=: i RANGE: ;~ONE: <br />34 3~ ~S ~W AR <br />WIDTH: 60 DEPTH: [~0 AR~A: 0hE ~REG,YES LOT: CORNER:N0 <br /> <br />MAP: <br /> <br />1 <br /> <br />TYPE: NANUFACTURED STRUCTURE PERNIT OR APPLICATION NO= <br />CONTRACTOR, NO. 75977 <br /> LAMAIN CONSTRUCTION <br />206 SE 4TH <br />TROUTO~LE, 97060-0000 <br />PHONE: 7&0~7756 <br /> <br /> ITEM <br />HANUFACTUREO STRUCTURE PLACEMENT/CONNECTION <br />MANUFACTURED STRUCTURE STATE FEE <br />HANUFACTUREO STRUCTURE STATE SURCHARGE <br />HANUFACTURED BTRUOTURE ZONING SURCHARGE <br /> <br /> TOTAL A$SESSEO FEES <br /> PREVIOUS RECEIPTS <br /> THIS REOEIPT <br /> <br />904~35! <br /> <br />QUANTITY AMOUNT <br /> $182.00 <br /> $20.00 <br /> $9.10 <br /> $~5.00 <br /> <br />$226.~0 <br /> $0.00 <br />$226.10 <br /> <br /> BALANCE DUE $0.00 <br /> <br /> RECEIVED BY: DM2 .......................... _~_~___- TYPE: OK CHECK If: 1152 <br /> <br /> * THIS iS NOT A PERNIT. THTS APPLICATION NUST GO THROUGH A REVIEW PROCESS WHERE THE <br /> FOLLOWING NUST RE CONPLETEO. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE <br /> THAT ALL NECESSARY INFORNATION HAS BEEN PROVIDED..~b~.~L.. -~~'O-~ ~,,O._ ' <br /> <br />PLANNING AC~ON: <br /> PLAN REVIEW: <br /> ZONING: BY <br /> <br /> RR~ <br /> CITY 2URISDIOTION: <br /> REMARKS: HF~ HOME <br /> <br /> OFFICE COPY <br />FORM # MC ~ 5-56 REV. <br /> <br /> <br />