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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 />DATE: Z2/,1,2/~4 TZ~E,: ?I~,54;29 <br /> <br />~S TUS ADDRESS; CONSTRUCTION TYPE'· ; OCCUPANCY: <br /> 5,~. ASPEN DR <br /> <br />[0~ dr ~Oi'~jF~CTLJRJ~D';' ~ L. STRUCTURE <br /> <br /> MILL CRAEEK ESTATES <br /> 163e COTTAGE S'F SE <br /> SAL,.EH. OR <~7~82 SITE NUMBE~: 94-~4~29 <br /> PHONE: ~7:l-~625 ~ VALUATION: <br /> <br /> 58 i 24 8S ~ 2W RM 51 <br /> <br /> TYPE: ~AN~FACTURE~ STRUOTURE PER~iT <br /> C~NTRACTOR~ I,lO~ 14922 <br /> CQMI,~ Wood,urn <br /> 285 .S Pacific Hwy <br /> Woool~urn. <br /> PFIONE: 981--~141 <br /> <br /> ITEH QUANTITY AMOUNT <br /> MANUFACTURED STRUCTURE PLACEMENT/CONNECTION $18~,~' <br /> MANIJFACT'URED STRUCTURE STATE FEE <br /> MANUFACTORED STRUCTURE STATE SURCHAI~GE $9. <br /> <br /> T(~TAL ASSESSED FEES <br /> I"'REV ~ OUS R£CEIPTS <br /> THIS EECE.T P'l <br /> <br /> BAL. ANCE DUE, , <br />JOI"JN ROEHM CON~TRUCTION: <br /> <br />$211,18 <br /> $0,00 <br />$2J. 1.i0 <br /> <br /> $0.00 <br /> <br />PAYEE:: , , INVOICE &278~ <br />RECEIVED ~Y~ PM TYRE: IN (;FLECK ~: ~ <br /> <br />FOLLOWING MUST BE COMPLETED.: IT IS THE ;R£SPONSIBILITY OF THE APPLICANT TO ASSURE <br /> <br />SETBACKS: <br /> <br />PR 10 <br />LS'"'15 <br />RS'-iS <br />RR"'15 <br /> <br />F'LANI,Il146 AC'lION: .... <br /> Z ON I NG: ~" ......... <br /> ~,, ,-,.- ,. BY ............. ,~,L ...... DA'rE% = '- '~'; ~ <br /> <br /> CITY JUR~[SD~[CTIQN: BY DATE <br /> ~EHARKS: HF:'G HOME. CARPORT ................... <br /> <br />OFFICE COPY <br /> <br /> <br />