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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 performing work on 8, property I own or OCCUpy, <br />I am ~ registered builder OR ) the authorized representative <br />ct a registered builder, <br />The work will be perforrl~ed by a registered builder. <br />Other~ <br /> <br />DATE: 05/12173 TZF. ME: <br />B[_AZER INDUS, 'fRIES <br /> <br />SIGNATURE OF APPLICANT <br /> <br /> DATE: <br /> <br /> 5'78o6-000 <br /> <br /> 94'5 0L. NEY <br /> AUMSV I LL.E; OR <br /> <br />USE OF BUILDING: <br /> HANUFACTUREI) STRUCTURE <br /> <br />'~(~N'rI~ACT CITY. <br /> AUiViSV ILL, E <br /> <br />JGS: <br />NO <br /> <br />F'0 BOX ;)33 <br />SILVERTON OR 97381 <br />PHONE; 749-3~62 <br /> <br />SITE NUNBER: <br />VALUA'FION: <br /> <br />LOT: BLOCK: <br /> <br />WIDTH: DEPTH: <br /> 965 <br /> <br />¢ECTION: TOWNSHIP; RANGE <br /> <br /> 24 85 2W <br />AREA. UNITS' RREG. LOT: <br /> 443900. SF qO <br /> <br /> CON,ERg J: AL <br /> <br />OCCUPANCY <br /> <br />)CGU eANT LOAE <br /> <br />NO OF 8EOROOMS <br /> <br />Il,ID <br /> <br />YES <br /> <br />TYPE: HANUFACTURE~ STRUCTURE <br />CONTRACTOR~ NO, <br />BLAZER INDUSTRIES <br />PO BOX 3Z5 <br />SILVERTON OR 97581 <br />PHONE;: 749'-~62 <br /> <br />PERHIT OR APPLICATION NO: ?84783? <br /> <br /> ITEM <br />MANUFACTURFD STRUC'rURE F'LACEMENT/CONNECTION <br />i~AHOFACTLIRED STRUCTtJRE STATE FEE <br />MANUFACTURED STRUCTURE STATI~ SURCHARGE <br /> <br />I'OTAL A~SESSED FEES <br />F'REVIOU~C; RECEIPTS <br />TNIS RECEIPT <br /> <br />QUANTITY AH£)UNT <br /> $182.08 <br /> $20, o0 <br /> $9,10 <br /> <br />$211,,:L0 <br /> $0,.00 <br />$211.10 <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE:.,. .. _ELAZER INDUSTRIES INVOICE. 49303 <br />~ECEtVE,~ BY: PM .................................................................. TYPE: IN CHECK ~. 0 <br /> <br />$ THIS I8 NOT A PER~IT. THIS APPLICATION HUST GO THROUGH A REVIEW PROCESS WHERE THE <br />¢OLLOWING MUST BE CONPLETED. IT iS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE <br />THAT ALL NECESSARY ~NFQRi~AT~ON HAS BEEN PROVIDE~. <br /> <br />PLANNING ACTION: <br /> PLAN REVIEW: BY % DATE <br /> ZONIN[;: BY .........................DATE <br /> SEF")' I C;i B Y '"_' ']:: '"~ :~ ] ~:: :] ]:]~ ."] ']']']]"] ~ ': <br /> <br /> CITY JURISDICTION: BY DATE <br /> REMA~I<S: RELOCATE MS OF'F'~O~?'Od F'ROPE~T? ...... <br /> <br />SE l BACk,.). <br /> <br />F'R 8 <br />L~ 0 <br />RS 0 <br />RR'"'O <br /> <br /> OFFICE COPY <br />F0~M ~ MC 15-56 REV. 4/90 <br /> <br /> <br />