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MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> <br /> 285 Church Street NE · Room 132 · Salem, Oregon 97a01-3670 <br />Office Hours: 8:00-4:30 * Phone:(503) 588-5147 * 24-HR Inspection Une: (503) 373-4427 <br /> <br />D~TE/TIHE = ~4/11/97 14=33 I~JF~CTUI~D D#ELLZ#£ <br />TYPE ; ~ Ha~factur~ ~11i~ <br />OCCUP~Y ; R-3 [~ ~ ~4/11/1~7 <br /> <br /> P~GE <br /> <br />WORK DESC : HFG REPLACEMENT <br /> <br />SITE A~DRESS : CITY: MARIOH COUNTY <br /> 12364 WEST STAYT~ RD SE ST <br /> <br />CROSS STREET : STAYTON RD <br /> <br />PARCEl_ NUMBER : 75718-12~ PROPERTY LOCATOR: 071W18C 80109 <br /> PARCEL SIZE : .7AC ZONE: EFU <br /> <br />OWNER NAME <br /> <br />APPLICANT <br /> NAME <br /> ~DDRESS <br /> <br />PHONE <br /> <br />: THOMPSON, CURTIS D & MONA JO <br /> <br />!~ THOMPSON, CURTIS & MONA <br />· 12364 W. ~TAYTOM RD <br /> STAYTON OR <br /> 97385 <br />: 769-7853 <br /> <br />CONTRACTOR/ : OOCB: <br />AGENT : <br />PHONE : <br />INSTALLER : MD LICENSE: <br />~HONE : <br /> <br />UNIT SO FT : <br /> <br />Units <br /> <br />Description Fee <br />Manufactured dwelling fee 245.80 <br />State surcharge 12.25 <br />State administrative fee 28.89 <br />Zone surcharge 29.88 <br /> <br /> ~sessed fees 297.25 <br /> ajustments .OB <br /> Total fees 297.25 <br />PAYEE: THOMPSON, CURTIS & MONA Total pax~ents: 297.25 <br /> Balance ~ue : .88 <br /> <br />~S G~RHIT IS HDN-TRAHSFERAOLE ~ EXPIRES 186 lAYS FROI! ISSUE DATE IF gORK <br /> N COI~. OR iF- COl~l~Ol~-~l~S FOR A PERIO~ OF 199 DAYS. OR IF <br />~CO~DiST~.Ol4 Flip'lolLS TO MEET RLL RE~UIREI~ENI~3 OF STATE LR~ ~ ,ARION COUNTY <br /> ES. UPON IJRITTE)I I~cOtAF. S'I'~ K ~X: I~ONTH ED~T~I~;IOI~ ~i~Y BE GR~tITED. <br /> <br />SIGNATURE OF APPLICANT: <br /> <br /> <br />