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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 pertormlr/g work on ~ property I own or occupy· <br />t am & registered builder OR ( ) the authorized representative SIGNATURE OF APPL CANT: <br />et a registered builder, .............. <br />The work will be performed by a registered builder. <br />Other <br /> <br /> : <br /> <br /> 9771 BROWNELL D~ ~E <br /> <br />,oo~NUFACTURE <br /> <br />TYPE: MANUFACTURED STRUCTURE PERMIT OR APPLICATIOH NO: <br />CONTRACTOR~ NO. <br />NICKS~ GERALDINE <br /> <br />PHONE: 769-44~0 <br /> <br /> ITEM <br />MANIJFAOTURED STRUCTURE PLACEMENT/CONNECTIOH <br />MANUFACTURED STRUCTURE STATE FEE <br />MANUFACTURED STRUCTURE STATE SURCHARGE <br />NANUFAOTURED STRUCTURE ZONINGSUROMARGE <br /> <br /> QUANTITY AMOUNT <br /> $182.00 <br /> $20.00 <br /> $9. :LO <br /> $15.00 <br /> <br />TOTAL ASSESSED FEES $226.18 <br />PREVIOUS.:RECE~P~$ $0.00 <br /> $22&.10 <br /> <br /> PAYEE: NICKS, GERALDI~ RECEIPT 55784 <br /> RECEIVED BY: W~ ~'~_~ ' ~ . TYPE: CK CHECK $: 2781 <br /> <br /> ~ THIS iS NOT A PERMIT. THIS APPLICATION HUST GO THROUGH A REVIEW PROCESS WHERE THE <br /> FOLLOWING MUST BE COMPLETED. IT IS THE RESPOI~I~IBILITY OF THE APPLICANT TO ASSURE <br /> THAT ALL HECESSARY IHFORMATIOH HAS ~EEH PROVZDED. <br /> <br />PLANNING ACTION: <br />PLAN REVIEW= ~Y DATE ~ , SET~AC~S~ FR <br />ZONING: BY ............ DATE .............. LS <br /> <br /> ~R ....... <br /> <br /> ~EMhRKS= ~S PI_ACENENT <br /> <br />FORM # MC 15-5~t REV, 4/90 OF FiLE COPY <br /> <br /> <br />