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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, 225 <br />22.0 HiGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:$0 <br />24 HOUR CODE-A-PHONE: 888-7904 <br /> <br />I am performing work on a property I own or oCCUl2y. <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 /> <br />I have read and agree to the terms stated on the reverse side <br />this document. <br /> <br />'OWNER; DA '¢~. ¢ 04/0&/94 <br /> STRAWI% FAY W. <br /> <br /> TAX LOT CATEGORY: <br /> , RESIDEMTIAL <br />...... ~ONSTRMCTION TYP6 I OCCU'PANGY~ <br /> <br /> R <br /> .OCCUPANT LOAD' <br /> <br /> 6720 6722 PETER i~;~D SE CONTRACT CITY: JOg; <br /> AUM.~;ViLLE OR 97;425 MARION COUNTY NO <br /> <br /> ~AMtJF'AC'TURE~) STRUCTURE <br />MAILING A~DRE~S'. SU 80IVISION: <br /> <br />PHONE: 749-28~8 <br /> <br />~ITE HUHBER: <br />VAL. UATION: <br /> <br />LO'[; BLOCK. SECTION TOWNSHIP: RANGE < ZONE; MAP; <br />,'WIGTH' DEPTM ~ R~E'~ .................. UNITS ~.S ...................... RREG. J'~ ................. LOT, iL-DORN~RzEJ'~U ............... ' ~e <br />~ ..... 10. AC NO ! NO <br /> <br />TYPE: MANUFACTURED STRUCTURE <br />CONfRACIOR~ NO~ 4&20~¢ <br /> PRUITT TRAMSFER ~NC <br />P 0 BOX 476 <br />LESANON~ 97~55-'0000 <br />PHUNE= <br /> <br />PERHIT OR ~IPPLICATION HO: 5~847 <br /> <br /> ITEM <br />MANUFACTURED STRUCTURE P[ ACEMENT/CONNECTION <br />MANUFACTURED ,~TRUCTURE STATE FEE <br />MANIlFACTURE]) STRUCTURE STATE SURCHARGE <br />~ANUFACI'OREI) STRUCTURE ZONING SURCHARGE <br /> <br />TOTAL AS!~ESSE~ FEES <br />PREVIOUS RECEIPTS <br />?HZS RECEIPT <br /> <br />QUANTITY AMOUNT <br /> $282~00 <br /> $20.00 <br /> <br /> $I5.00 <br /> <br />$0,,00 <br /> <br /> 8AEANCE DUE $0.00 <br /> PA~EE~ ~^^ ~ REI;EIPT <br /> <br /> $$ THIS IS A VALI9 PERHIT $$ THIS PERMIT,FEE COVERS,ONE INSPECTION AH9 ONE <br /> RE~NSPECTIOH. ~LL ~LOCKIN§~ STRIR INST~LLRTION~ PLUH~IN~HECH~NIC~L~ AH~ ELECTRICAL <br /> CONNECTIONS ~RE RE~U[RE~ TO ~E COHPLETE9 UPON REQUEST FOR THE FIRST INSPECTIOH. IF <br /> ~HY OF TH[ ITEHS ARE ~NCONPLETE~iAN A~ITIONAL [N~PECT[ON FEE ~ILL ~E REOU~RED. <br /> PERNIT RS VALi9 FOR SIX MONTHS ONLY. REEE~ED FOR & NOHTNS UPON ~R~TTEN EEOUEST FOR <br /> ~H EXTEHSISN~ PRIOR TO THE EXPiRaTION 9A~E OF THE PERM[T, ~F CONSTRUCTION F~ILS TO <br /> HEET ALL REOUIREMENTS OF STATE LA~S AHD ~ARION COUNTY BUILDINg AND ZONIN~ ORDINANCES~ <br />PLANNIN6 ACTION: <br /> SETBACKS: FR 20 <br /> LS-100 <br /> RS-lO <br /> RR-;leO <br /> <br /> SMALL 500 GALLON SEPTIC TANK. RECOMMEND PUMPING EVER~-T~O YEARS. <br /> <br /> REMARKSr, M, . HD,~F. AL., <br /> <br />OONALt) E,, WI:)OI)LEY, MARION COUNTY BUII.;D~(NG OFFICIAL / BY <br /> <br /> OFFICE COPY <br />FORM # iMC 15.56 REV. 4/90 <br /> <br /> <br />