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ApPlication Received
<br />
<br /> Date ~'
<br />
<br />Date ~
<br />
<br /> Marion C~unty '
<br /> DE, eT, 0~,' eUl~Ol~
<br />"': :: -'~'-*,". :.'~.:~:,:2 :::i'~.. '.:. '.' ..,~;.. : ECTION .
<br /> r N,E: ' ~.,.
<br /> SALEM, OREGON 97:~01-
<br /> ' ~8-5147
<br />
<br />APPLICATION FOR PLUMBING PERMIT
<br />
<br /> NOTE: Applicants must hold Oregon Registration to COnduct a Plumbing
<br /> hiring outside help [~. Indicate status.
<br />
<br /> Job Address ~
<br />
<br />Owner
<br />
<br />Plbg. Installer,
<br />
<br /> BIdg,, Permit
<br />
<br />property owner/operator not
<br />
<br />Phohe
<br />
<br />Phone~~']
<br />
<br /> E OF PERMIT '~'{',, NO. OF ITEMS FEE ON EACH TOTAL AMOUNT
<br /> -- ~-",~,,. ,' ............. "~ B.O0
<br /> ,,~- ..... ~.~,~.~
<br />
<br /> M'i~ceUancous ixtures , , $2.00 ...........
<br />se~er ~ica Line ~ $~,,:00
<br />With Plumbing Turn-around , ::: , . $5.00 ....
<br />C~mmerci~i ": ...........
<br />1 t0 50 Fixtures ............... ,, $2.00 eS,:,,.
<br />Over ~0 Fixtures ,
<br />Aite~ati~n~ & ~diti nS ,, ,..,., ' .............. ~ ~ ........ ' ,",'
<br />Charged at Commercial Rates :" ,, , :,,~,.~,,.. ·., ~ ..... ~, ,,:: .,~
<br />lawn,,Sprin,ki'i~ ..... '~,"-;,,T,-----~'' '' :: ,',::~ ;~-[~:':;~': .......... , .....
<br /> T0 and including each Pr0,~ctive device $2.00 .............
<br /> TOTAL AMOUNT ALL ITEMS ~ ¢ ~O
<br /> , SURCHARGE
<br /> ~ - GRAND TOTAL ,
<br /> ,,, ~ ,, ,, ,,,,;,, ~,.,, ,,, , ~,. ,,,
<br />
<br />certfy that all plumbing work w~ll be done ~n:accotdance*:w~th, apphcable:,.prowstons of, Oregon
<br />and 693 and app cab e codes, and that no, he p w ,be emp eyed un eSS ~consed under ORR 693,
<br />
<br /> ................. : ...............
<br />
<br /> Return Comple~.e Application With ,the .Indicated Fee.
<br />
<br />Revised Statutes Chapters 447
<br />
<br /> .........
<br />
<br />
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