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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 builder, <br /> <br /> MAILING AOORESS; H3:LL CREEK ESTATES <br /> ~7~ HILL CREEK RD SE ..... <br /> AUMSV~:LLE, OR 97325 ~ SITE NUHBER~ <br /> PHONE: 7~-7744 ' VALUATION: <br /> <br />~W~OTH: 55,gS~T"" 84 ~A~eA, 4628. ]UNITS, II ¢~EG. LOT, <br /> <br />TYPE.' NANUFACTUREI) STRUCTURE <br />COI,ITRACTOR~ 1,10~ 98940 <br /> Ca,)l~'oI Aun~l'l~l / ~a~lt:zaM HoMem <br />~18 ]all~.ywood <br /> <br />PHONE: <br /> <br /> ITEM ': <br />MANUFACTURED G'fRUCTURE PLACEMEI,IT/CONN~CTION <br />NANUFA[;TUREB STRUCTURE ~l'ATE FEE <br />MANUFACTURE9 S'fRUCTUR~ S XATE ~URCHARGE <br /> <br />PERMIT OR APPLICATION NO: 9868o9~ <br /> <br />TOTAL ASSEgSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />BALAHCE DUE <br /> <br />QUANTITY AMOUNT <br /> $182.00 <br /> $20.00 <br /> $%10 <br /> <br />$211.10 <br /> $0.00 <br />$~11.10 <br /> <br />P~,Y. EE:: Capitol Awfd, ng / San'[i,~M HO~es P,,- IN¥OICE 62695 <br />REMZIVFI) ~Y: PM .............. .._J_~_L .............. TY E, IN CHECK ~: 8 <br /> <br /> THIS IS NOT A PERHIT. THIS APPLIBATIOH HUST ~O .THROUGH A REVIEW PROCESS WHERE THE <br />FDLLO~IN~ MUST BE COflPL/TED. IT IS THE RES~NSIBILITY OF THE APPLICANT TO ASSURE <br /> <br />SETBACKS: FR 10 <br /> LS-15 <br /> RS-15 <br /> AR'"'15 <br /> SP[ .......... <br /> <br />OFF!CE COPY <br /> <br /> <br />