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Received by: <br />Date " <br /> <br />MARION COUNTY BUILDING INSPifiCTION <br /> COMMUNITY DBVBLOPMENT CENTER <br /> 285 Church St NE · Room 132 PERMIT NO: <br /> Salem, OR 97301 <br /> <br />2,4. Hi' la~p~tiorJ Lin~ 58S-7~O4 <br />OIFw,~ 588-5147 8:00 a.m. - 4:30 p-m, <br />FAX: 588-7948 <br /> <br />PLUMBING PERMIT APPLICATION <br />Pleaso complete all Sections, I through 5 <br /> <br />1. LOCATION OF ]lq'$TALLATION <br /> <br /> o-- <br /> ' 4~ <br /> <br /> P~ A~ NON-~NS~B~ AND ~PI~ IF WORK IS NOT I <br /> STARED ~IN I~ DAYS OF ISSUAN~ OR IF <br /> WORK Iff ~USP~D~ ~R lg0 DAYS. <br /> <br /> CO~ACTO~ ~ST~LATIOH O~Y <br /> <br />Pl~nNng <br />~ntta¢~r's BoaMRgg. No. ~ I I gl / JobNo. <br /> <br /> FOR OW~R ~ST~LATiONS <br /> <br />PropeRS, Owner (plottse print) <br /> <br />Mailing Address <br />City/State/Zip <br /> <br />3. PLAN RBVIItW sF~2TION <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 />MC13-45 <br /> <br />Date: <br />issued by: <br /> <br />4. FEll SCHI~DULg (Complot¢ and enter total in Al below) <br /> <br /> RESIDI~NTIAL [2 COlVIM~CIAL [2 <br /> USE OF STRUCTURll: <br /> NEW ILl ALTERATION ~1 ADDITION El RELOCATION CD <br /> <br />BASE FEE <br /> <br />I[~SIDIiNTIAL (cinch fixture) <br /> Aurora Dwelling Plvmbing Fee <br /> <br />dw~Iling unit <br /> New mns~ction $10,~ <br /> <br /> Recon~ct $ 5,00 <br /> <br /> Fimt I~ R, or l?agtion ~emof $20,00 <br /> For ca, ad~fl' 1~ R, (up to <br /> maximum ofS~ ~.) $15.00 <br /> <br /> Fimt I~ ~. or fraction ~ $~,00 <br /> ~r ad~nl' 100 ~, (up to <br /> nm~um ofS~ ~,) $15.00 <br /> <br /> maximum of 5~ <br /> <br />OTHER (~teqoiredbyOSPSC ~ad Building OEicia0 <br /> <br />DWELLING PI~RMiT LABEL # of L~bel~ <br /> <br /> No. X pcc ~2~// <br /> <br />__ sq, fl. x $.065 r-__ <br /> <br />_N/C_ <br /> <br />A2, Add 5% surcharge 605 x Al) $ <br /> <br />(A 1 + .25), if ~qulred $ <br />C, InveatigationFee (if~qu~d) $ __ <br />D, Rci~sp¢ction Fee ($25,~) <br /> <br />Receip~ No, __ <br /> <br />$25.00 <br /> <br />$15.00 <br /> <br />sis.00 <br /> <br /> <br />