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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM1 OREGON 97301 <br /> <br /> PHONE: 588-514'7 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />of a registered builder, <br /> <br /> S~TUS ADDRESS'. 'r CONSTRUCTION TYPE; i OCCUPANCY; <br /> · ~,i,~,, A~F'~N ])[~ , ~ S ] CONTRACT CITY; ~ UGB: O~UPANT LOAD: <br /> ~ JHSV" I E OR 97;~25 ~IJI~SVILI_E [~![ <br /> OF BUILDING; : ~NO OF 86DRO0~S: <br />i ~NI,JF ~CTURE)) STRUCTURE 3 <br />MA LNG ADDR~8S ~ <br /> <br /> 2416 S'[A'f'E ST <br /> Pl,'f C:~l,I F ," <br />iLOT: BLOCK'. SECTION; <br /> <br /> )EPTH: <br /> <br /> 52 93 <br /> <br />48~6. <br /> <br />SITE NUHBER: ~'4-03146 <br />VALUATION: <br /> <br />TOWNGHfP; <br /> <br />~ NO ' bio <br /> <br /> TYPE: N~NI.IFACTURE9 STRUCTURE PERHIT OR ~PPLTCATTON NO: <br /> [,ONTI,~A£,I'OE~ NO. 9B74~ <br /> Capitol A~ning / Sa~:La~ HoMes <br /> 5:f, 8 Valleywood" Dr SE <br /> Sa ].em~ 97386 <br /> PHONE: 36Z--17:[ 1 <br /> <br /> :[TEM P , QUANTITY AHOUNT <br /> MANUF'AC1URED STRUCT[JRE [.ACEHENT/CONNECTION $182. <br /> HAHUFACTURE~ STfEJCTURE STATE FEE <br /> flANtJF'ACTiJRED STRUCTURE STATE ~uRcJLIARGE $9.!8 <br /> <br /> TOTAL; AS,:~EGSED FEES $211,. <br /> ~ : PREVIOUS RECEIPTS $0.0~ <br /> .,> . . <br /> I THIS RECEIPT $,.11, i~ <br /> : ,~ BAL, ANCE' DUE $8.,88 <br />...... " ..... : ]:HVOICE 598~8 <br />RECEIVED BY: F'H . ............................. ~-,,- ..................... ~:,.:~,=~-:.: TYPE:~: ~h[ CHECK ,~,. <br /> <br />FOLLON~NG HUST ~E COHPLETED. [~ IS: THE RESPOHS[9~L[TY OF THE flPPL[C~NT TO <br /> <br />F'LA~( REV]:EW:: BY ~, DATE' ~:~;~ SETBACKS: FR 1~ <br />ZONi;N~;: ~Y .................... DATEr' ~:~::~%' -"' LS'"'~.5 <br />SEa:mit,.,. ATE'iE2iZ'Z:ZZ:ZZ'='Z r s'-ls <br /> : RR <br />CITY JLli:(:I::D]:[,'f']:OFL BY DA'Ti:~ SP- <br /> <br /> OFFICE COPY <br />FORM # MC 15-50 REV, <br /> <br /> <br />