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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: 58B-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 ~/&Nj~.,I~ <br /> The city ha~ jurisdiction for review <br />I ~m ~erformlng WOrk on a property I own or occupy, <br /> and aPprO~! ,Of plans, end [nspec- <br />Iofame registereda registeredbuilder,bUllder OR the authorized representative SIGNATUR~ 0¢ APPLTCANT: ti~ Cf' t~e system. Contact the city <br />The work win be 9edorme~ Dy a registered builder. , <br />o~er prior to beg~nM~ construction. <br />I have reed and agree to the term~ stated on the reverse side of DATE: <br />this document. <br /> <br />AUHSV];}.I,,,E OR 97~25 ]AUMSVILI E ~ NO <br /> <br />P0 BOX 278 <br /> E <br />HUBBAkD,, OR 97~3 I SITE NUHB~R: 95-~264 <br />Pi,,IO NI~:: ~'81- 4125 ~ VALUATION;, <br /> I <br /> <br />TYPE: HANUFACTURED STRUCTURE PERHIT OR APPLICATI[IN NO: <br />[~OHTRhCTOI% NI~,, <br />C.,AHPBELL FIOME:b <br />7911 SQUIRREL HILL RD <br /> <br /> I'rEM <br />HANtJFACTURED STRUCTURE PLACEHENT/~,ONNECTZON <br />HAHUFACTURED STRLJCTIJRE STA"E <br />MAMJFACTURE~ STRUCTURE S'[ATE <br /> <br /> ~" - FEES <br /> <br /> ,? <br /> <br /> :: <br /> <br /> PAY,..,~ .... <br /> I:~ECIL:'IVE~ BY" DF' <br /> :** THIS iS A VALID PERHTl~I <br /> REtN~PECTION. ALL BLOCK; <br /> [;ONNECTIONS ARE REQUIRED <br /> ANY ElF THE ITENS ARE <br /> PERMIT l~ VALID FOR S~X <br /> <br /> NEET ALL REOOIRENEHTS <br />F'I.Ah/NIHL; AC'TZON: <br /> <br />QUAHT;[TY AHOUH f <br /> $182. <br /> $2~,, 00 <br /> $9.1o <br /> <br />$211,, I0 <br /> <br /> $0.00 <br /> <br />INVOICE <br /> <br /> AND ONE <br /> AND ELECTRICAL <br /> FIRST IF <br />I~;FEE WILL BE REQUIRED. <br /> :BPON WRITTEN REQUEST FOR <br /> :~F CONSTRUCTION FAILS TO <br /> DI~ AN~ ZONING O~DINANCES, <br /> <br />SETBACKS~ FR 18 <br /> L S'"':I. ~J <br /> RS-15 <br /> RR'"15 <br /> <br />OFFICE COPY <br /> <br /> <br />