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Received <br /> <br />220 High Street NE ~= <br />Salem, orege, s7301 <br /> <br />PLUMBING PERMIT APPLICATION <br /> <br />~ O~~wner: Phone: Address: <br />Situs Address; <br /> <br /> Plumbing installer; Phone: Address; <br /> Home Bul~der~ Registration No.: ....... "' ' ' <br /> - ........ <br /> Rasldentla[: ~' New: ~ Addition: ~ ~cupanoy ~ U~e~Building: <br /> Commercial: ~ Alteration; <br /> <br /> NO. FEE AMOUNT <br /> Sase Price $1o.oo <br /> · Residential , <br /> New construction (each fixture) $ 7.50 <br /> Alterations (each fixture) ~L 7.50 .... ~.'~ O, ~ <br /> Re-located Residence (eech fixture) . 3.75 .. <br /> Commemial <br /> New Construction (each fixture) 7,50 <br /> Alterations (each fixture) ......... '- 7.50 <br /> Water Lines <br /> For the first 100 feet or fraction thereof 20,00 <br /> For additional 100 feet . 15.00 <br /> Sewer Service Lines <br /> First 100 fcet or frection thereof ' 30.00 <br /> Additional 100 feet 15,00 <br /> Lawn Sprinkling System · · <br /> To and including each protective device .......... 5.00 ..... <br /> Other (as per OSPSC and Building Official) <br /> On-Site Technical Review (apply at Marion Countyonly) <br /> Re-Inspection Fee <br /> FEE $ ~0, ~ <br /> STATE SURCHARGE ~1.,~ ~',~t <br /> PLAN REVIEW FEE $ I <br />DOUBLE fee $ <br />Please return COMPLETE APRLICATION FLEETSURCHARGE $ 7~ ~ '~ i <br />with the indicated fee. CITY FEE $ ~t ~ <br /> <br />) I.mperfOrmingwOrkOn~.propertylownoroccupy~ , {//~ V~~ <br /> arna registered builder OR ~ j the authorized representative ct $1GNATU RE OF APPLICANT; <br /> <br /> Other. <br /> <br />MC 15-45 <br />Rev. 3/87 <br /> <br /> <br />