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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: S88-G147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />ImmaregisteredbutlderOR( )the~uthorb:edrepresentative <br />of a registered builder, <br />The work will be performed by a regis[ered builder, <br />Other <br /> <br />SIGNATURE OF APPLICANT: <br /> <br /> .'325¢,SI-"IEN DR -- ~8 [I CONTRACT CITY: ' ' 'T (J-~B~, <br /> -.A'-L-Li'iSy,~L,.,!:,,,F- _[!r(. ?7325 ~.OUNT ANI...EL SO ' <br />USE OF BUfLDiNG'. ......................................................................... <br /> <br /> 2 <br /> <br /> 1630 COTTAI;,E 81' SE <br /> ~AI..EM~ OR 773~82 I SITE fluM~F~', <br /> <br />TYPE= HRNUFACTURE~ STRUCTURE PERMTT OR APPLICAT]'ON NO.' <br />CONTRACTOR. I,}0. 14722 <br /> C0f'~H Wood[Hxrn Inc <br /> <br />Woodburn. <br /> <br /> ITE~ <br />MAt,ILtFA~TURE~ STRUCTURE PLACEMEI,tl'/COIINECTION <br />NANUF'ACTURE~ STRUCTURE STATE FEE <br />HAFIUI=ACTURED STRUCTURE STATE SURCHARGE <br /> <br /> TOTAL ASSE,,~SED FEES <br /> PREVIOUS RECEIPTS <br /> THIS RECEIPT <br /> <br />6~179 <br /> <br />9UANTITY AMOUNT <br /> $182.80 <br /> $28,,00 <br /> $9.10 <br /> <br /> ~ALARCE: QU£ $0,00 <br /> PAYli;;E: INVOICE <br /> RECEIVED BY: <br /> ................................ :::: ..................................... .... . ~YFE. CHECK .~. 0 <br /> ** THZS ZS ~ ¥~LZ~ ONE INSPECTZON AN~ ON£ <br /> R~INOPECT~ON, ALL BLOO~N~¥A~:~N~TALLAY.~OH~PLU~BZN~ H~CNAN~CAL AND ELECTRICAL <br /> CONNECTIONS ARE REQUIRE~ TO BEco~PEETE~'OPON ~EOUEST FOR TNEFIRST I~SPECTION. IF <br /> ~.g[ ~E_ITEHS_~RE ~E REQUI~ED. <br /> F~KMZT I~ V~LID FOR SIX ~ONTHS::UNLY; RENEWE~ FOR & HONTRS UPON WRITTEN REQUEST FOR <br /> AN EXTENSZON~ <br /> ~EET ~LL REBUZ~ENENTS OF STATE L~S AN~ ~EION:COUNTY ~UILgIN6 RN~ Z~N[NG OR~N~NCES~ <br />PI..,ANN:[I,IG ACTION: <br /> <br />SETBACKS: FR 10 <br /> LS--15 <br /> RS 1,.~ <br /> RR--~5 <br /> SP:': ........... <br /> <br />DOl,tPd,,.O E. WO£IDLEY, MARION COUNTY BUILDING OFFICIAL / BY <br /> <br />OFFICE COPY <br /> <br /> <br />