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Plumbing Permit Application MARION COUNTY <br /> ~ ~ DEPT. OF BUILDING INSPECTION <br />.... /f~,~z_ , ~ ~,~' -A~ Senator Building # 225 <br />,~,ppl. ~e~~,~:5~ 220 High st., N.E. C'nd F ocr <br />By:.( ~'~?~:~. Salem, Oregon 97301 <br /> R,H. WlTHROW, BLDG. ADMINISTRATOR <br /> <br /> ~91dg,, Permit No,, <br /> <br /> Plbg,, Permit No, <br /> <br />5::00 P,M.. ............ CODE-A-Phone §88-5373 ............. 8:00 A.M, Date: <br /> <br />Plumbing Permit Application <br /> <br /> Tax Lot No:: <br />,'~~ Sec ....... Twnehp. Rge. <br /> <br />Address ,,, ~ Phone <br /> <br /> TYPE OF PERMIT NO. O~ iTEMS FEE ON EACH TOTAL AMOUNT <br /> Sase Price $10.00 <br /> Residential I .................. <br /> <br /> K,!,t,chen Ur~it Includes Water Heater , , ' ...... ,$~5,~0.,0 <br />...... Bath Unit (full) 10.00 <br /> Bat h,,.Unit (half) ,~ 5.00 <br /> Laundry Unit ...... 500 <br /> Sewer Service Line <br /> Private - Shall be ch'~rged per 100' or f~[~tion thereof lO,,00 <br /> Commercial .................... <br /> 1 to 50 Fi×tares ....... 500 ea. <br /> Over 50 Fixtures 3.00 ea. <br /> Alterations & Additions ............................ <br /> Charged at Commercial Rates <br /> Lawn Spr.inkllng sYstem ... ' ................. <br /> To and including,,each protective d~vice 5-00 <br /> FEE ~ . ~ <br /> Please return complete application SURCHARGE <br /> with the indicated fee. <br /> TOTAL ~*~ <br /> <br />1 <br /> <br />I agree to perform work according to the submitted plans and specifications, the ~aws 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: <br /> <br />I am a registered and licensed plumber or <br />The authorized representative of a registered and licensed plumbing contractor. <br /> <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) <br /> <br />SIGNATURE OF APPLICANT: <br /> <br /> <br />