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MARION COUNTY BUILDI.,NG 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 Hou CODE-A-P.ONE: <br /> <br />I am performing work on a property I own or occupy. <br /> <br />of a registered builCer, <br />/'he work will be ~erformed by a registered builder. <br />Other. ~ __ <br /> <br />this document <br /> <br />wNDA'fE: 12/06/90 'I~IE: 10:'tT:lg <br />O ER <br /> KNOX, f41CHAEL G · LINDA L <br />SITUS ADDRESS: <br /> <br />fax LOT: CA'fEGORY. <br />CONSTRUCT ON TYPE OCCUPANCY: <br /> <br /> 6691PETER~ ROAD <br /> AUC4SVILLE OR 9?325 <br /> <br />USE OF BtJ~LDING' <br /> <br />UGB: OCCUPANT LOAD: <br /> <br />I~AR~ON ~N'I'Y NO <br /> <br />MAILING ADDRESS: ~-- SUSOIV SION: <br /> <br />10955 JA~ES [."~Y DRIVE <br />AUNt~VILLE 97325 <br />PHONE: 749-2155 <br /> <br />LOT: bLOCK: <br /> <br />WIDTH: DEPTH: <br /> <br /> 5I'i'E NUIVIB ~R: 9586 <br /> VALUAT ION ** <br />SECTION TOWNSHIP: RANGE ZONE MAP: <br /> <br /> 19 8,~ 1N AR <br />AREA: ~JNITS R~qEG LOT CORNER' <br /> 7. AC YE~ NO <br /> <br />TYPE: I/~OBILE HOfvlE PER'~iT OR APPLICATiON NO: <br /> <br />CON'fRAC'rOR, NO. ~UERBONS <br />GUERDONS <br />~[lO0 ROAO <br />SI'AYI'ON <br />PHONE: <br /> <br /> i'fEN <br />f408ILE HOME BASE FEE <br />Iv~OBILE hOfflE STATE FEE <br />¢,1081LE HOC4E ZONING .SURCHARGE <br />~'LEE'f ~¢JRCHARGE -ZONE 3 <br />¢4OBI'LE HOf~E STATE ~URrJHARGE <br /> <br />9029124 <br /> <br />'TOTAL A,.S,SES.SED FEP. T5 <br />PREVlOU,S RECEIPTS <br />'tHIS RECEIPT <br /> <br />QUANTITY AI~OUNI' <br /> $89.25 <br /> <br /> $5.25 <br /> ~3.84 <br /> 5.25 <br /> <br />$119.94 <br /> $o.0o <br />$119.34 <br /> <br />BALANCE DUE $0.00 <br /> <br /> PAYEE: KNOX, MICHAEL G & LINOA L "~X RECEiP'I' 30?82 <br /> RECEIVED BY: 01vt2 ~~ TYPE: CK CHECK ~: 2901 <br /> <br />$ THJ~ J$ NOT A PER, il'. THIS APPLICATION FUST:GO THI~6H A R~i~ P~ ~ERE THE <br />FOLL~N6 ~8f BE ~PLEfED+ ~T ~8 THE ~S~8~L~TY OF THE A~LI~T TO ~RE THAT <br />ALL NECB~ iNFO~TI~ H~BE~ P~VIDED. <br /> <br />sgP'rzc: BY .......... ~ ........... DATF..,,.,/,~i~,,' , i :~. ~ ....... CiTY JURi.SOlrj'f'lON: BY ............... DATE ............ <br /> <br />RENARKS: N~SIEJE HOC,IE ........... R~;728 ........................................... <br />PLANNING AC'f'fON; p (~0'~- <br /> <br />OFFICE COPY <br /> <br /> <br />