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MARION COUNTY BUILDING INSPECTION <br />SENATORBLDG NO, 225 <br />220 HIGH STREET NE <br /> SALEM: OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br /> <br />I 8m perforrBmg work on a groperty I own or occupy <br />I am 8 registered builder OR ( ~ the authorized representative SIGNATLIR~ OF APPLICANT <br />el a registered builder, <br />Tho work will be performed by a registered builder <br />Other <br />I ha~e read and afpoo [o the terms stated O~ the reverse side Of DATE <br /> <br />HAMPTON, riMOfHY <br /> <br />R~SiDENflAL <br /> <br /> 1]'~ SIEiNKA~P RD <br />AUM~VI LLE <br /> <br />OR 9?325 <br /> <br />SE <br /> <br />CONTRACT CITY UGB OCCUPAN I LOAD <br /> <br /> S~4mE <br /> <br /> PHC)NC-: ?49-2502 $i]E NUtV]BER: ?002 <br /> VALUA f i ON' <br /> <br />WIDTH DFPTH AREA 32 UNITS ~ TRREG LOT ~W CORNER AR <br /> 3.19?99995 AC NO NO <br /> <br />48 <br /> <br />TYPE: PLUf'flglNG <br /> <br />PERt, lIT OR APPLiCAilON NO: 90242~1 <br /> <br />CON f I,¢,,C l OR, NO. <br />HANIPfON, f iI~DIHY <br />SAf~4E <br /> <br />PHONE; ?49-2502 <br /> <br /> lrsJ~ <br />WA[~R LINES, 1S'T ]OD F~E'[' <br />SEWER LINES, 15T 100 FgEi <br />IvlOBZLE HOME ~W~R ANO WATER C~NNECFiON <br />PLUMBING BA~E ~EE <br />FLEEr' ~URCHARGE -ZONE 3 <br />PLUmiNG 5]AiE ~RCHA~E <br /> <br />rOTAL~F_.,,.SS~D FEES <br />PREVIOUS REC6iPTS <br />THIS RECEIPT . <br /> <br />QUANiiIY <br />I $20,00 <br />] $30,00 <br />1 $25,00 <br /> $20.00 <br /> ~3,84 <br /> <br />$103,59 <br /> $0.00 <br />$103,59 <br /> <br />BALANCE DUE <br /> <br /> HAMPTON, TiMO¥'H¥ ~ R~CEiPI NO: 25665 <br />RECE1V£O BY: cl TYPE; CA CHECK ~: 0 <br /> <br />x< THI~ IS NOT A PER~IT. THiS APPLICAT.I[C~I IvlU~ST ~0 THI~IUGIH A REVIEW PROCES~ iiC¢iERE THE <br />FOLLO~IN6 I',IU~T I~E C(~,PM~TED. IT IS 'Fr~E RE~N~IBILITY OIF THE APPLICANT TO A..,.~;=URE THA'r <br />ALL NECI~!iEA~RY INI=O~TiON HAS BEEN PROVJ[IDEO. <br /> <br />PLAN REVIEW: BY .............. DATE ................ <br />REE'~RKS: WL, SL CON <br /> <br />CI]Y JURiSOiC]iON: BY ......... DAli ....... <br /> <br />OFFICE COPY <br /> <br /> <br />