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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: 585-5'147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />registered builder, <br /> <br />I DAf'E: 0,7~/J. 8/94 'F );HE;: 9:48=57 <br /> <br /> 225 F'ATTOH RD ~_ '~"~ i [~* o <br /> <br />, HAMMOND ADDITION <br />,WIDTH: OEPYH ' A~A ~ UNI~x , I~G. LOT: i C~ER: . ~. <br /> <br />TYPE: i)WELLIN6 .PERI4IT OR APPLICATION NO: <br />CONTRACI OR,, <br />SHAF'F'ER. MICKEY <br />1218 THZRD <br />STAYTON,, OR <br />PHONE= <br /> <br />bBEI, t..ZN6 ~IJZL~ZN6 FEE <br />9WELL. IN[; <br /> <br />~WEt. L ZNI; ELECTRICAL <br />~WEL. L]:N6 STATE <br />D~ELI,.ZN6 PL.~N <br /> <br /> ?1~55111 DP <br />ARCi-tI'FECT/ENC;[NEER, NO,, <br /> <br />PHONE: <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />IHIS RECEIPT <br /> <br />BALANCE DIJE <br /> <br />QUANTITY <br /> <br />ANOIJNT <br /> $221 ,, 40 <br /> !l~SO,, 73; <br /> $20,. 1 :[ <br /> $63;,, 04 <br /> $.1.9.28 <br /> $185.00 <br /> <br />¢587.54 <br /> $0.00 <br />$58~.,54 <br /> <br />$0.00 <br /> <br /> F AYEI.... SHAFFER, HICKEY 57582 <br /> RECEIVED BY: P~ I'YF'E: T.I.I CHECK ~:,., 0 <br /> · THIS IS NOT A PERNIt% THIS ~PPLICATZOH HUST GO THROUGH A REVIEW PROCESS NHERE THE <br />FDLLON~NG HUST BE COHPL~. [TJIS THE RESPOHSZDZL~TY OF THE APPLiCaNT TD ~S~U~E THaT <br /> LL NECESSARY INFORMATION <br /> H~S ,BEEN PROVIDED. <br /> '~.Aq R~VIIEW~ BY ~ DATE~ ' ~ ' = - ~-T~'N'~,, ~l'~ ~r~ <br /> ........... ._ · .... ,.,, .......... ..,.,..,. <br /> ?DA~[.,,. ~Y ........ ~ ..¢~._ <br /> <br /> ~ ' -~ T''~'~r ....... F'LCN.ACTZON: ~ IRR"'J, 5 <br /> , ] ENERGY PATF ~ SF'"' <br /> F,I:'FY ..?R.[~JDICT ON:/OY DATE , ......... <br /> P,F_H~RkS:: NE.W RES <br /> <br />COPY <br /> <br /> <br />