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Appl Recd <br /> <br />By <br /> <br /> Date. <br /> <br />Bldg, Permit No <br />PIb.g Permit No. <br /> <br /> Date <br /> <br />~-767 Du~ore ~g' <br /> <br />Owner Terry S(~i. th <br /> <br /> - ,,. Sec TwnshD __ Rge <br /> <br />Phone,~ 371-33'91~e~OSeway Ct. $~ 1335 <br /> <br />Plbg Installer, Beskow ,Plbg. .,Add~ess, 810 Sh'ipping' St. NE Phone 581-5848 <br /> <br /> Base Price ..... <br /> Residential . <br /> New construction (each fixture) 1 0 $,-7cS~ <br /> ( ) ?.0o <br /> Alterations each fixt-~e ; .... <br /> Re-located Residence (each fixture)' ,.' ,~ "%' .,3'75. ' <br /> <br /> ........... · 7.5b <br /> New Construction (each fixture) , <br /> Alterations {each fixture) <br /> ~/.~ ~ ~ ~,'/V~ <br /> For the first 10~,~eet or fraction them0f ~ ~ / 20.00 <br /> For additional 100 feet ~ , 15,00 <br /> Sewer Se~ic;'~in~s ~ ~ ~ .... <br /> ~Flrst 100 feet o~ fraction thereof <br /> ~dditional 100 feet ~ <br /> Lawn Spnnkling System . . .,~, ~ _ ~,:~_..,;,~ ~ . , <br /> To and nc ud ~g each prote~ive desi~ ~ ~ , 5.00 <br /> Other (as per OSPSC'and Building Official) "' ' <br /> , FEE <br />P ease ~eturn COMPLETE APPLICATION ' ' ~LAN REVIEW FEE <br />~ ~ '' ' ~1'''* ..... ~'~'* .; ; .'*t''~%U' ¥~'~/ 2'''¢ ~ I'""~''~' ~FEEE~ SURCHARGE <br />_ TOTAL <br /> <br />I agree ~o perform WOrK according to the submitted ~laps and sR. ec,ifications, the laws of, the State of Oregon and the <br />Ordinances of Marion County PERMIT EXPIRES JF'~N,O~,K;,NQT,'.ooMMENCED ~VITHIN 180 DAYS, I further <br />expressly warrant that I comply with the provisions 'of~ORS 70%005 to 701 125 because; <br /> <br />( i I e.m 8, registered and licensed plumber or <br />(~ The authorized representative of a registered and licensed p ur~bing contractor <br /> <br />The work will ce performed by a registered and licensed plumber <br />I am performing work'on a property J own or occupy <br />Other tplease specify) <br /> <br />'' $'~NATUR~ O~ APPLICANT: ~__/~_ Bldrs. Board Reg., 4'1719 <br /> <br /> <br />