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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 /> <br />I am performing work on a property I own or occupy. <br /> // <br />l am~ registered builder OR the authorized representer,ye SIGNATURE OF APPLICANT: ........ ~_ ~__~____--. ~ <br />of a registered builder. ~ ~ <br /> <br />The work will be pedormed by a registered builder, <br />Othe[ <br /> <br /> .. . r~, n 8- 4D~ R_ D NF <br /> <br />PHONE: '749- ].604 <br /> <br />~DTH: "IDEPTH: l AR EA'. , . ~ UNtT~; ~'IRREG, LOT; ~'~OR NER'. <br /> i~,~0 ! 212 ~ 21200. ~ SF ~NO ~ I,]0 J <br /> <br /> .................... iu iiiii <br /> <br /> TYPE: MANUFACTU~E~ ST~UCT~R~ PER~IT OR APPLICATION NO: 9~52418 <br /> ~T[' ' ( ' t' <br /> COil ~CT]R~. iLL, <br /> F:LL.:[ S,~ CARCO <br /> <br /> F 04~.. 749-16Q4 <br /> <br /> ITEM ..... 6!~ ANTITY <br /> HANUi~'.'ACTUI~E~ STRUCTURE P~ACEHENT/CONI~ECTION <br /> ~fiAI,IUFACTURED STRUCTLIRE STATE I:'E[~ <br /> MANUF~:CTURED STRUCTURE S~AI~ <br /> ~tANUFACTURED STRUCTORK Z~NII,I,~ SbR(,HAR~.. x.:~ : <br /> <br /> PAYEE:I INVESTORS <br /> RECE~'VED [~,Y;,, gl... <br /> <br /> * THiS IS NOT A PERMIT. <br /> FOLLOWIH{;- MUST BE <br /> THAT ALL NECFSSARY <br /> <br />F'I,,.ANN;[N~ ACTION: <br /> PLAN REVIEW: I~Y <br /> <br /> CT:'T'"r' JUR:~/8~]:f:;T:i:ON; BY <br /> <br />t~A'I'E. ........ == ,, <br /> <br /> AMflUN'I- <br /> $182,88 <br /> $28,, <br /> $9,, <br /> $15. ¢},9 <br /> <br /> $226,, :L <br /> $0.00 <br /> <br />RECEIPT 5487~ <br />CHECK :~,: 256~ <br /> <br /> PROCESS ~HERE THE <br />APPLICANT TO <br /> <br />SE]'iSACKS: F'R ~ ~ <br /> S P ........... <br /> <br /> <br />