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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 />of a registered bdllder. <br /> <br />2~757 6~SE R9 NE ' <br /> <br />'E;4i'Lt~8 ~,6~f~!FACTURED' STRC C~URE ...... i sueolvlsloN: <br /> <br /> SAME ~ <br /> PHONE: &78-58~e , L VALUATION: <br /> <br /> ~ ..................... <br /> <br />TYPE: MANUFACTURED STRUCTURE <br />CONrRACTOR~ NO. 14865 <br /> SMS Mobile Ho~es I~c <br />l].20 Old Sheridan Rd <br />Mc~innvil~e~ 97128-08¢8 <br />PHONE: 472-4685 <br /> <br />PERHIT OR APPLICATION NO: 58769 <br /> <br />ITEM <br />MANUFACTURED STRUCTURE PLACEMENT/CONNECTION <br />MANUFACTURED STRUCTURE SI'ATE FEE <br />MANUFACTURED STRUCTURE STATE 8URCHAREE <br />MANUFACTURE~ STRUCTURE ZONING SURCHARGE <br /> <br />PAYEE:: <br />RECEIVED BY: DF <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY <br /> <br />AMOUNT <br /> $182,00 <br /> $20.00 <br /> $~.10 <br /> $15,00 <br /> <br />$226.10 <br />$2,~,6.10 <br /> $0.00 <br /> <br />BALANCE ]UE $0.00 <br /> <br /> RECEIPT <br />TYPE: CHECK ~: 0 <br /> <br /> ** THIS ~S A VALID PERMIT ** ftlIS PERMIT FEE COVERS ONE INSPECTION AND ONE <br /> REINSPECT~ON. ALL DLOCKING~ STAIR INSTALLATION. PLUM~INC~ MECHANICAL~ AND ELECTRICAL <br /> CONNECTIONS ARE REOUIRED TO BE COMPLETED UPON REQUEST FOR THE FIRST INSPECTION. IF <br /> ANY OF THE ITEMS ARE INCOMPLETE. AN ADDITIONAL INSPECTION FEE MILL DE REOUIRED. <br /> PER~IT IS VALID FUR SiX MONTHS ONLY. RENENED FOR 6 MONTHS UPON HRITTEN REQUEST FOR <br /> AN EXTENSION. PRIOR TO THE EXPZRATION DATE OF ~NE PERMIT. IF CONSTRUCTION FALLS TO <br /> ~EET ALL REQOIREMENTS OF STATE LA~SAN~ NARIbN'COUNTY'DUILDING AND ZONING OROiNANCES~ <br />PLANNING ACT31ON: ' <br /> <br /> RE~ARKS: MS/AU:ELD PE:YES'RECEIYED*10/i~l/~4 <br />BONAI..D I£. WOODLEYv MARION COUNTY BUILDING oFFioiAL / BY <br /> <br />SETBACKS: FR 2~ <br /> LS-20 <br /> RS::20 <br /> RR 20 <br /> SP: ..... <br /> <br /> OFFICE COPY <br />FORM # MC 1~-~6 REV, <br /> <br /> <br />