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MARION COUNTY BUILDING INSPECTION <br /> · SENATOR BLDG. NO. <br /> . 220 HIGH STREET NE <br /> SALEM, OREGON 9730, <br /> <br />I am a rg,giotered t~uilder OR ( ) the authorl;~ed repr~e~tative SIGNATURE O APP,,k.)G~I,.~ <br /> <br />ARENDT,. L.AFRY .......... 41846-000 RESIDENTIAL <br /> <br /> AURORA OR 97802 ~ARION COUNTY ~YES <br /> 2 <br /> <br /> PHOME: 678-5898 ~~-~~; VALUATION: <br /> <br />TYPE= HAHUFACTURED STRUCTURE PERHIT OR APPLICATISH <br />CQNZRACTOR, N0. 14865 <br /> SMS Hobile HoMes ln6 <br />1120 Old Sherida~ Rd <br />Mcmin~ville~ 77128-0000 <br />PHONE: 472-4685 <br /> <br /> ITEM <br />MANUFACTURED STRUCTURE PLACEMENT/CONNECTION <br />MANUFACTURED STRUCTURE STATE FEE <br />MANUFACTURED STRUCTURE STATE SURCHARGE <br />MANUFACTURED STRUCTURE ZONINGSURCHARGE <br /> <br />9~58769 <br /> <br />QUANTITY AMOIJNT <br /> $182.00 <br /> $20.80 <br /> $9.10 <br /> $15.00 <br /> <br /> TOTAL ASSESSED FEEs $226.10 <br /> PREVIOUSRECEIPTS $0.00 <br /> :TH~S RECEIPT $226.18 <br /> <br /> ' $0.00 <br />PAYEE: ARENDT, LARRY ,/-~ ! '" :. , RECEIPT 61J39 <br /> <br />$ THIS IS HOT A PERHiT. THIS,APPLICATIoH:HUST,GO THRouGH A REVIEW PROCESS W~ERE THE <br />FOLLOWING HUST ~E COHPLETE~. IT:iS THE:RESPORS~ILIT¥ OF THE APPLICANT TO ASSURE <br />THAT ALL HECESSARY IHFORHATIONHAS]BEEH PROVIDED <br /> <br /> . <br /> <br /> .......... :.. <br /> <br />CITY ,JURISDICIION, BY DATE <br /> <br />FORM # MC 15,58 REV, 4A30 <br /> <br /> <br />