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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 - 4:80 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />i am a registered builder OR ( ) the authorized representative SIGNATURE OF APPUC <br /> <br /> f~× Ldf~ CATEGORY <br />°WNER:~)ATE: 06/16/94 TIME: .!.5:57:05 <br /> <br /> J2235 ~EST STAYTON ~D SE ~, <br /> <br /> SITE NUHgER= 94-~2991 <br /> PHONE: 769-324~ VALUATION: <br /> <br />TYPE: MANUFACTURED STRUCTURE PERMIT OR APPLICATION <br />CONTRACTOR,~_ <br />WOOSLEY, A&LEN & <br /> <br />PHONE; 769-324L <br /> <br /> Il'EH <br />HANUF'ACTOREI) STRUCTURE PLACEMENT/CONNECTION <br />MANUFACTUREQ STRUCTURESTATE FEE <br />MANUFACTURED STRUCTURE 5TA'TE SURCHARGE <br />~ANUFACTURED STRUCTURE ZONING SURCHARGE ' <br /> , <br /> PREVIOUS RECEIPTS <br /> RECEIPT <br /> THIS <br /> <br />QUANTITY AMOUNT <br /> $182.08 <br /> $20.00 <br /> $9.10 <br /> $15.80 <br /> <br />$226.10 <br /> $8.00 <br />$22~.10 <br /> <br /> BALANCE DUE $0,08 <br /> <br />PAYEE: ~¢OOSLEY~ ALLEN & KAY, RECEIPT 58977 <br />RECEIVED BY: c.£ :,,T,YPEi;,:CK CHECK ~: I67 <br /> <br />~ THIS iS N0I A PERMIT. REVIE~ PROCESS WNERE THE <br />FOLLOWIN[ MUST BE COHPLETED.: APPLICANT TO ASSURE <br />THAT gLL ~ECE~S~RY ::::: <br /> <br />~ITY,JURISDICTION: BY : DATE SF-' .... <br />REMARKS: ms/ss auth p'~=~:~ .................... <br /> <br /> OFFICE COPY <br />FORM # MC 15-56 R~V, <br /> <br /> <br />