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Plumbing Permit Application MARION COUNTY Plumbing Permit Application <br /> <br />Appl,, Recd:: ~c- <br />By: <br /> <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Suilding # 225 <br /> 220 High St., N~E. 2nd Floor Bldg. Permit No. <br /> Salem, Oregon 97301 <br /> R.H. WITHROW, BLDG. ADMINISTRATOR Plbg, Permit <br /> 588-5147 -- 588-5148 <br />5;00 P,M.- ............ CODE-A-Phone 588-§373 ............. 8:00 AM. Date:: <br /> <br />Type of Permit:: <br /> <br />Tax Lot No:, <br /> <br />Address: <br /> <br />Bldr, & NO,:: ,,.~X'~ ~' C~Ot~2-~ <br /> <br /> Sec,__Twnshp, ,Rge. <br /> <br />Address: ~0 GO'/( 3~-.~ -~"T'~)~),~O,~, <br /> <br />Plbg,, <br /> Installer <br /> <br /> TYPE OF PERMIT NO, OF ITEMS FEE ON EACH TOTAL AMOUNT <br /> <br />Base Price ................. $1 O, .0,0 <br />Residential <br />Kitchee Unit Includes Water Heater $15.00 <br />Bath Unit (full) 10.00 <br />Bath Unit (half) 5.00 <br />Laundry Unit 5.00 <br />Miscellaneous Fixtures 5,,00 <br />Sewer Service Line <br />Private - Shall be charged per 100' or fraction thereof ...................... 10,00 <br />Commercial <br />1 to 50 Fixtures .............. §-00 ea, <br />Over 50 Fixtures 3,00 ea,, <br />Alterations & Additions <br />Charged at Commercial Rates <br />Lawr~ ~prir~kiing System ....................................... <br />To and including each protective device 500 <br /> c~ J"~"'~' FEE <br />Please <br />return <br /> complete application SURCHARGE <br /> with the indicated fee. <br /> <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: <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 />