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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 />this document. <br /> <br />SIGNATURE OF APPLICANT: <br /> <br />, .-.,,,.,,....--.-."....~ r ~,, .......... <br /> TAX LOT: i CATEGORY: <br /> P;[ETROK, RAY RESIDENTIAL <br /> CONSTRUCTION TYPE; OCCUPANCY: <br /> <br /> 10182 SHAF'F RD SE '~f~TRAb~81~'Yi <br /> ; OOCU¢ANT LOAD: <br /> AUHSVIL[_E 0R 973~,¢ , HARION COUNTY~ N0 ~ <br /> <br /> ............. ' ........ <br /> <br />TYPE: HECHANIEAL PERMIT OR APPLICATION <br /> <br />CONTRACTOI'~,~ N0. 34604 <br /> Judson~,~ <br />PO Box 12~69 <br /> <br />PHONE: <br /> <br />GAS CONNECTION <br />FORE AIR FURNACE UNDER 18~8~8 BTU <br />HECHANICAI,,, BASE PEE <br />MECHANICAL STATE SURCHARGE <br /> <br /> i¥OTAL ~ <br /> ASSESSED FEE:, <br />PREVIOUS RECEIPTS <br />. THZS ,BECE~PT ' <br /> BALANCE DUE <br /> <br />QUANT:[TY AMOUNT <br />1 $2.00 <br />i $6.00 <br /> $10.00 <br /> $0.90 <br /> <br />$18.90 <br /> $0.00 <br />$18.90 <br /> <br />$0,, 00 <br /> <br /> F'AYEE: Judsom~ tm: RECEIF'T NO,", 52476 <br /> RECE:I:VED I:}Y~ DH <br /> ............................... ================================-_-==:;==============.;m======== TYI:E: CK CHECK :~2 2980 <br /> <br />CONSTRUCTION CEASE~ FOR A PERI8~ OF 18~ ~AYS, OR IF CONSTRUCTZON FAILS TO MEET ALL <br />EQUIRE~ENTS OF STATE LAWS AND HARION COUNTY BU~LDtN6 AND ZON~N~ O~INAWgES, THIS PER~T <br />ALL BECOEE NULL AN~ VOlB. <br /> <br /> RE~ARKO: GL/FURN ~ , ~ <br /> DONALD E,, WOOgLEY~ ARION LQUNTY BUILDING OFFICIAL / By <br /> <br /> OFFICE COPY <br />PORM ~ MC 15.56 REV, <br /> <br /> <br />