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FOR CITY VALIDATION[ <br />Ree~i~ed by:__ <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 />IPLUMBING PERMIT APPLICATION <br /> Please complete all Sections, I through <br /> <br /> l. LOCATION OF INSTALLATION <br /> <br />l~crlption/Div~[iom: <br /> <br /> PE.P. MITS ARB NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTF. D WITHIN 180 DAYS OF ISSUANCE OR IF <br /> woRK susPr o , FOR <br /> <br /> CONTRACTOR INSTALLATION ONLY <br /> <br />Con~"acto~ O f~. . <br /> <br />Plmnbing Board: <br /> <br />2.B. FOR OWN'ER INSTALLATIONS <br /> <br />Pmpeziy Owner (pleasopr~t~t) <br /> <br />Mailing Address ] Phone <br />Cily/S~a~dZip <br />Owner% Slgnatute: <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and Catot total in A1 below) <br /> <br /> R~][]DBNTIAL I-I COMMERCIAL [] <br /> USE OF STRUCTURE: <br /> NEW m ALTERATION m ADDITION ~ RE. LOCATION [] <br /> <br /> No. X Fee -- Sum <br />BASE FEE <br /> <br />RESIDENTIAL (e~ch fixtor~) <br /> A~ora Dwelling Plumbi~ Fee sq. fi. x $.065 = <br /> <br />dwelling unit <br />N~w ~n$t~tlon $10,00 <br />Altaratio~ $10.00 ~. <br /> <br /> Relocated S[~tu~ $ <br /> Modular S~cturc $ 5.~ <br /> <br /> max~um of 5~ fi.) $15,00 <br /> <br /> For ad~l' 100 ~. (up to <br /> ~ ~5~ ~,) $15,~ ......... <br /> <br />COM~RCI~ (~vh f~) <br /> <br /> R~c~t $10,~ <br /> <br /> ~um of5~ ~,) $15,~ __ <br /> <br />OTHBR (as r~quirod by and ~ildi,~ Ol~oiM) <br /> <br />DWELLINO PERMIT LABEL # of Labels I~IC <br /> <br />3. PLANRBVIBW 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 1.¢45 <br /> <br />5. FEES <br /> Al. Enter total of fcca feO(l~ Se.C. g4 <br /> A2, Add $% s~harg¢ (.05 x Al) <br /> <br />B. Enter 25% of line A1 for PI~n Review <br />(A 1 * .25). if ~eqoi~d $ __ <br />C. Inve$ligation Fee (if~quired) $ <br />D. Rcimpcet~a Fee ($25,~) <br /> <br /> TOT~ ~0~ D~ $,~ <br /> <br /> <br />