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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 a property I own or occupy. <br />I am a registered builder OR ( ) the authorized representative <br />of a registered builder, <br />The work will be performed by a registered builder. <br />Other <br />) have read and agree to the terms stated on the reverse side of <br />this document. <br /> <br />, OWNER'. TAX LOT'. <br /> MARK i 71010--8~0 ~ REoIDENTZAL <br /> 0VERFIELD,, <br /> <br /> 13648 WISTERIA I)R NE , CONTRACT C YY: UGB: <br /> AURORA OR 97002 i i~ARION COUNT~ NO ~ : <br /> MANUFACTURED STRU~'fURE <br /> <br /> ~ ~EER CREEK ESTATES <br /> PO BOX 25~ <br /> HUBBARD OREGON 97~32 8I~E ~HBEA~ ~4-~8881 <br /> PHON~: ~81-7187 VALUATION: <br /> <br />, 78j 142~ I SF i YES I NO <br /> <br /> TYPEI 'HANUFACTURED STRUCTURE PERHIT OR APPLICATION HO: <br /> CONTRACTOR~ <br /> O~ERFIEL~ HARK <br /> PO BOX <br /> HUBBAR~ OREGON ~78~2 <br /> PHONE: ~81-7187 <br /> <br /> II'E~ QUANTITY A~OUNT <br /> EANUFACTURED STRUCTURE PLACEMENT/CONNECTION <br /> HANUFACTURE~ STRUCTURE STATE FEE <br /> HANUFACTURED ~TRUCTURE STATE SUR~HABCE <br /> <br /> P~EV~OU8 :RECEIPTS $22~. 18 <br /> ~HI8 RECEIPT <br /> <br /> PAYEE: RECE?T <br /> RECEIVE9 BY: PB ......... CHECK ~: <br /> <br /> CONHECTIOHS ARE REQUIRED TO::BE'CO~EETEg'UPOH::,REG~ST::FOR THE FIRST iRSPECTIBN, IF <br /> <br /> ' PERHIT IS VAL[~ FOR SIX flGHTHS:OHLY~, EE~E~ 'FOR 6,~HTHS UPOH ~ITTEH REQUEST FOR <br /> i AH EXTEHSZOH~ PR[OR TO THE EXP[R~TIOH :DATE OF THE ~RH[T,~ :~F CONSTRUCTION FAZLS TO <br /> PLANNING ACTION: <br /> , SEIBACKS, FR 28 <br /> <br />[~[,HAAKS., HFG HONE <br /> <br />I)ONALD L:.. WOODLIEY~ HARIOW ¢O.]NIY BUII.I)IN60FF];I.'LI;AL / BY <br /> <br />~O~M # ~¢ t~-~.~v, 4/¢ OFFICE COPY <br /> <br /> <br />