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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br />Other <br /> <br /> PHONE: $88-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> SIGNATURE OF APPLI~AN'~~ <br /> <br />i have read and agree to the terms stated on the reverse side of <br />this document, <br /> <br />I)ATE: 12/12/94 TIHE; 9.~ 59:45 <br /> <br /> '$'lfJ,J$ ~OO~E~i I OONSTRLJCYJON ~gPE; ; OSCOPANCY: <br /> <br /> 18637 STAYTON rd) <br /> ~ ' ~ ~'~; 6CCU~AN~ LOAD: <br /> AIJ~tSViLI. E OR 97~m ~ ~NTY <br /> <br />'-GAmLm~ XOo~E~ ....................................................... <br /> <br /> 916 H BIRCH C/O I)EblNIS OLSON <br /> STAYTON,, OR. 97~83 <br /> PHONE: ~69,-5~88 VALUATION: <br /> <br />~LOY'. - rBL~K; - -J~E~¢I~N~ ~ [TOWNSHIP'. ~ RANGE'. ( ZONE: ~ MAA'. <br /> ' ' , .' <br /> <br /> TYPE= HANUFACTURE~ STRUCTURE PERmiT OR APPL.~CAT~O~ N~ <br /> 60HTRACTOR. <br /> C,"IUF, CH OF' GO~ OF PRBPI~ECY <br /> 9].6 N ~ZRCH 6/0 9ENI,IZS OLSON <br /> ~T~YTON~ OR. 9758~ <br /> ~ HOblE: 769~5888 <br /> <br /> ~ TEH ~U~NTZTY ~OUNT <br /> HANUFACTURE~ STRUCTURE PL..ACEMENT/~ONIIECTION $182. <br /> MANUF'ACTURE~ STRUCTURE STATE FEE <br /> MANUFACTUREQ STRUCTURE STAT~ SURCHARGE <br /> MANUFACTURED STRUCTURE ZONIHG SBRCHARGE ¢15,,~ <br /> <br /> TOTAL ASSESSE~ FEES $226. <br /> PREVIOUS RECEIPTS <br /> <br /> PAYE~: ~.K OLSON CONSTRUCTION: RECEIPT 62796 <br /> RECEIVE~ BY~ js .... ~2~. TIRE: :OK CHECK '~: 8124 <br /> $ THIS IS NOT A PERMIT. ~HI9 APPLICATION HBST: :GO' THROUGH A REVZEW PROCESS WHERE THE <br /> FBLLOW~NG HUST ~E CgHPLETED. :I:T ZS THE" ~SPONS~9~L~ GF, THE ~PPLICANT TB ASSURE <br /> THAT ALL NECESSARY IHFORHAT~ON HAS:::~EEH PROV~E9; <br /> <br />OFFICE COPY <br /> <br /> <br />