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FOR CITY VALIDATIOn] <br />Receive~lby: [ <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />24 Hr Insp~tion Linc: 558-7904 <br />Office.: 588-$147 $;00 a.m. = 4:30p.m. <br />FAX: 585-7948 <br /> <br /> PLUMBING PERMIT APPLICATION <br /> Please complete all S~ctions, 1 through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />1,,1, ^dd~,~ ~) '?'7~ " <br /> <br />PERMITS AIt~ NON-TRANSPI~RABLE AND EX PIP~ IF WORK IS NOT <br />STARTED WITHIN 1 ~) DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Mailing Addrcaa <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />O.n..,s,g.._, <br /> <br />Agem'$ <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />MC Lq-'t5 <br />Roy. 12/94 <br /> <br />PERMIT NO: <br /> <br />Date; <br /> <br />Issued by: <br /> <br />4. FIi}i SCHBDWL~ (Complete and ~nt~r total m A1 below) <br /> <br /> REiSIDI/N'TIAL ~7 . COMMI/RCIAL ~ <br /> USE OF STRUCTURE: ..,,, ,~ <br /> NEW Gl ALTERATION'~ A{DDITION [3 RELOCATION <br /> <br />BASE FEE $20,00 <br /> <br />RESID£NTIAL (~¢h fixture) <br />Aurora Dwelling Plumbing <br /> <br />Single Family or ~nulli-family per <br />dwelling unit <br /> <br /> maximum of 500 ft.) <br /> <br /> For ea. addnl' lOO ft. (up io <br /> maximum of$O0 ft,) <br /> <br />Smhar7 & $~mn Lines <br /> FJ~t 1~ fl, or f~cfion <br /> ~r ad~l' I~ fl, (up ~ <br /> m~ of 5~ fl.) <br /> <br />PROT~IVg BA~W DgVI~E <br /> All o&~ <br /> <br />-- sq, ft, x $.065 = __ <br /> <br />OTHER (as tvquired by 08P$C <br /> and Building O~eiaO <br /> <br />DWELLING PERMrr LABEL <br /> <br />ffof Lalmh <br /> <br />$10.00 <br />$1o.o0 <br />5.00 <br />5.00 <br />SD0 <br /> <br />$20.00 <br /> <br />$15,00 <br /> <br />$15.00 <br /> <br />$10,00 <br />$1o.oo <br />$1o.oo <br /> <br />$25.00 <br /> <br />$15.00 <br /> <br />$15,00 <br /> <br />FEB8 <br />A 1, ]gnter total of fe~ from g~. #4 $ <br />A2, Add 5% surehatg~ (,0,5 x Al) $ <br /> ~bt~al <br /> <br />B, ~ter 25~ o~ [mt A l tot PI~ R~vi*w <br /> <br />C. Investigation Fee (ifmqui~) <br /> <br /> TOT~ ~O~ D~ $.~ <br />Receipt No, , <br /> <br />$4,50 <br />$ I0.00 -- <br /> <br /> <br />