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Plumbing Permit Application MARION COUNTY Plumbing Permit Application
<br /> DEPT. OF BUILDING INSPECTION
<br /> Senator Building # 225
<br />Appl,, Recd: t~,;Ti" 220 High St-, N.E, 2nd Floor
<br /> Salem, Oregon 97301
<br />By: ~'~ R.H. WITHROW, BLDG. ADMINISTRATOR
<br /> 588-5147 -- 588-5148
<br />Date;; 10_1]~_ o 5::00 P,M. ............CODE-A-Phone 588-5373 ............. 8::00 A.M, Date:
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<br />Bldg,, Permit No,,
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<br />Plbg Permit No.~
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<br />Type of Permit:
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<br /> ~ ·'~ . ' ¢~,,, ~ '.i .~,~,~:fO,'¢.;'~
<br />Address: ~ ~/., ,:~":
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<br />Bldr. & No.:, '",: :" ": ~he~'
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<br />da,;¢,¢,~ Tax Lot No::
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<br /> Sec. Twnshp ,, Rge__
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<br /> Phone:__ Address::.
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<br /> Phone:__ Address:
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<br />Plbg,, Installer Lr:,:,'~e~'c:,'l 'q" "' r, Address = :~oO Co,~:,qo ci!-_l :,~ Phone.
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<br /> TYPE OF PERMIT NO. OF iTEMS FEE ON EACH TOTAL AMOUNT
<br />Base Price $10,00
<br />Residential
<br /> Kitchen Unit '"i'~ciudes Wa,!,?' Heater ...... , ...... / $15;0~
<br /> Bath Unit (full) ...... "~ ~ 10.00 ~,, ~0(
<br /> Bath Unit (half) §,00
<br /> Laundry Unit / 5.00 .~,
<br />Miscel]aneous Fixtures ~r ~, -~¢~ ::~ 5.00
<br />Sewer Service Line
<br />Priw!,~ · Shall be ~harged per 100' or frac!,[on thereof ..... 10,00
<br />Commercial
<br />I tO 50 FiX.t,~?,? .......... 5,00 ea.;i
<br />Over 50 Fixtures 3,,00 aa.
<br />Alterations & Additions
<br />Charged at Commercial Rates
<br />Lawn Sprinkling Sys,!em ................
<br />To and includln§ each,,p?tective device .......... 5,,00
<br /> FEE
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<br /> Please return complete application SURCHARGE
<br /> with the indicated fee.
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<br />I agree to perform work according to the submitted plans and specifications, the laws of the State of Oregon and
<br />the Ordinances of Marion County~ Permit expires if work not commenced within 120 days. I further expressly war-
<br />rant that I comply with the provisions of ORS 701.005 to 701.125 because:
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<br />I am a registered and licensed plumber or
<br />The authorized representative of a registered and licensed plumbing contractor.
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<br />The work will be performed by a registered and licensed plumber
<br />I am performing work on a property I own or occupy
<br />Other (please specify)
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<br />SIGNATURE OF APPLICANT: (~~
<br /> ¢ /
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