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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: 588-5'147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I sm performing work on a property t own or ooovpy, <br />I am 8 registered builder OR the authorized reprssentatlve <br />o a registered builder, <br /> <br />The work will be performed by a re§iste~'ed builder, <br />Other ........ <br /> <br /> OATE: Ll/~0/92 TIME: <br /> <br />:°WNEmGREEN, 50E <br /> ~I~US ADDRESS: <br /> <br /> 11646 FALCON CT <br /> AURORA <br /> <br /> NE <br />OR 97002 <br /> <br />MANUFACTURED STRUCTURE <br /> <br />PO BOX 759 <br />PORTLAND, OR 97207 <br />PHONE; 685-9685 <br /> <br />SUBDIV[$tON: <br /> CENTURY MEADOWS <br /> <br /> SITE NUHBER: 92-04139 <br /> VALUATION: <br /> <br />LOT: BLOCK: SECTION'. <br />WIDTH; DEPTH: AREA: <br /> <br />3S l,W RA <br /> <br />MAP: <br /> <br />]_ <br /> <br />TYPE: MANUFACTURED STRUCTURE <br />CONTRACTOR, NO. 73977 <br /> LAMA[N CONSTRUCTION <br />206 SE 4TH <br />TROUTBALE, 97060-0000 <br />PHONE: 760-7736 <br /> <br />PERHIT OR APPLICATION NO: 9044168 <br /> <br />ITEM <br />MANUFACTURED STRUCTURE PLACEMENT/CONNECTION <br />MANUFACTURED STRUCTURE STATE FEE <br />MANUFACTURED STRUCTURE STATE SURCHARGE <br />MANUFACTURED STRUCTURE ZONING SURCHARGE <br /> <br />TOTAL ASSESSEO FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />BALANCE DUE <br /> <br />QUANTITY AMOUNT <br /> $182.00 <br /> $20.00 <br /> $9.10 <br /> $15.00 <br /> <br />$226.10 <br /> $0.00 <br />$226.10 <br /> <br />PAYEE: LAMAIN CONSTRUCTION INVOICE 46222 <br />RECEiVEO BY: PM ....................................... TYPE: C~ CHECK ~: 1218 <br /> <br />· THIS iS NOT A PERMIT. THIS APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST BE COMPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE <br />THAT ALL NECESSARY INFORMATION HAS BEEN PROVIDED. <br /> <br />PLANNING ACTION: ,,.- , .~ <br />PLAN REV EN: <br />ZONING: BY _:~__.?~.'"--~ .......ZEE DATE_J <br /> <br /> CIYY JURISOICTION: BY ................ DATE .......... <br /> REMARKS: <br /> <br />SETBACKS: <br /> <br />FR I~ <br /> <br />RR,J_¢~_.. <br />SP ......... <br /> <br /> OFFICE COPY <br />FORM # MC 15,56 REV, 4/9o <br /> <br /> <br />