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Received By: ~ <br />pate:- P'l -g ? <br /> <br />MARION COUNT~ BUILDING INSPECTION <br /> <br /> ~alem, Oregon 97301 <br /> <br /> Phone 588-[i147 <br /> <br />PLUMBING PERMIT APPLICATION <br /> <br />Job Address: ~;~ ~, · <br />Plumbing ~ns~llep ~ <br />Home Bull~r~ Re i~t'ratJon NO " <br /> <br />Residential: ~ New: ~ <br />Commercial: ~ A~ration: ~ <br /> <br />Phone: <br /> <br />Site No.; <br /> <br />Phone: <br /> <br />Addition: [] <br />Relocation: [] <br /> <br />Occupancy Uj~t~ of Building; <br /> <br />Base Price <br /> <br />Residential <br /> New construction [each fixture) <br /> <br /> Alterat ons (each f xture) <br />~le-located Residence (each fixture) <br /> <br />New Construction (aachlflxture) <br /> <br />Alterations [each tixtu~) <br /> <br />Water Lines <br /> For the first 100 feet or fraction thereof <br /> <br /> , For additional )00 feet <br />Sawer Service Lines <br /> "Fimt 100 ieet or fraction thereof <br /> <br />Additional 100 feet <br /> <br />Mobile Home sewer/water connastiol~ <br /> (maximum $ feet lengmJ <br /> <br />Other (as per OBP$C and Building Off c al/ <br />On-Site Technical Rev ew apply at Mar on County on y) <br />Re-inspection Fee <br /> <br />P ease return COMPLETE APPLICAT ON <br />with the indicated fee, <br /> <br />,, ) Iarn performing wor~ on a pmpe, rty I own or occupy. <br />( ~ am a registered builder OR ~ ~ the authorized reoresentati~ of <br /> <br />NO. <br /> <br />$ 9.00 <br /> <br />9,00 <br /> <br />4,$0 <br /> <br />9,00 <br />9.00 <br /> <br />20,00 <br />15,00 <br /> <br />~0.00 <br />15.00 <br /> <br />25.00 <br /> <br /> 25.00 <br /> FEE <br />STATE SURCHARGE <br /> PLAN REVIEW FEE <br />INVESTIGATION FEE <br />FLEET SURCHARGE <br /> CITY FEE <br /> T L <br /> <br />AMOUNT <br /> $20.00 <br /> <br />agree ~o install e~o~ling to the slJbrniffed plans aha specifications, thelaw~ of the sta~ ot Oregon and {he ordinances of Marion Count~, <br /> <br />Rev, 13~7 <br /> <br /> <br />