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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 a registered builder OR ) the au horized rep esen ave <br />TI, e werk will be performed by a registered builder. <br /> <br />AtH,;~¢'~¢1[~ E OR 97325 ¢ '~VIL..E r'tO <br /> <br />AUN,.~/.:.L~ ....... t.)k ~7,:% SZTE HUMBER: <br />F1.1ONE= 378'-'8~68 VALUATION;~ <br /> <br />TYPE: MANUFACTURED STRUCTURE PERI'IT OR APPLICATION NO: <br />Cf~,llrk(lf,,T(,Ik~ NO., 9254? <br />1;AC~F'~ELL HONES <br />7~1:( SQUIRREL HIt,,I,,, <br /> <br />FHONE= 37,~ <br /> <br /> I 'TIZH <br />HAIqUFACTURE~) STRUCTURIE: PLACEF~ENT/CB~NECTION <br />NA~'IUF¢~CI'[.)I¢([!:~) STRUCTURE S'rA~E FEE <br />HANUFACTtJRED STI'~UCTURE STATE SURCSAR/;E <br /> <br /> 'l'OreaL ASSESSED FEES <br /> i: PREVIOUS <br /> TH~S RECEIPT <br /> <br />57187 <br /> <br />QllAH'fI'rY AMOUNT <br /> ~:i. 82,.0~ <br /> $20.00 <br /> ~.:[.0 <br /> <br />$~ 1:1. ,, zO <br />$2;I. ;[ ,, t0 <br /> $0.00 <br /> <br /> RECEIVE]) BY',', l)~ ZNVO]:CE <br /> ........ - ............. - .............. ,_ .................... _ '[YFE CHECK ~. <br /> ~ THIS I¢ ~ VALI~ COVERS ONE INSPECTION AND ONE <br /> ~EINSPECTION. ALL BLOCKIHG~:S~A:IR'"';N~ALLA~ON~:, PLU~BIN~ MECHANICAL, AN~ ELECTRICAL <br /> CONNECTIONS ARE REQUIBED TO::'BE 'CO~PEETED U~NREQOEST FOR THE FIRST INSPECTION. <br /> ANY 0¢ THE ~TEMS A~E INCOmPlETE, ~H WILL BE <br />PER~IT IS VALI~ FOR SlX ~ONTHS oNLY; RENEWE~ :FOR 6 MONTHS UPO~ ~RITTEN REQUEST FOR <br />AN EXTENSION. PRIOR TO THE EXPIR~TI8W BATE OF THE PEBHIT. IF ~8NSTRUCTlO~ FAILS T8 <br />MEET ALl. REQ8I~E~ENTS OF STAT~ LAWS ~ ~A~i~M ~QUNTY BOlLgING ANB ZONING ORDINANCES, <br />PLANHING ~6IIEN~ <br /> , I , ~ETBACKS: F'R <br /> ...S <br /> <br /> ,,,t, ,K, ~ MFI;; HON~; ............ <br /> r",,~ D E, t¢OC,il)L_EY,¢ ~AR'.i;ON-'( [;hlY' ~LU. LD.,'~ ~!(~ OFF'ZCIAL / BY .....................................................................................~ <br /> <br />OFF]CE COPY <br /> <br /> <br />