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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER PI::HMIT bio: <br /> 285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />24-Hr Inspectior~ Lhle: 588-7904 <br />Office: 588-5!.47 8:00 a.m. - 4:30 p.m, <br />FAX: 588-7948 <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all Sections, 1 tflrough <br /> <br />1- LOCATION OF INSTALLATION <br /> <br />Prop:ny Owner <br /> <br /> pERMITS ARE NON.TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> ~TARTBD ~I~IT}ilN 1 S0 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 18o DAYS. <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />Joomcyman's Plumbe-es No. <br /> <br />2,B. FOR OWNI~tR INSTALLATIONS <br /> <br />l~ro~a04/Owne~ ~ole~ se <br /> <br />Mailing Address <br /> <br />City/State/Zip <br /> <br />Owner'~ Signature: <br /> <br />3. PLANREVIEW 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 1545 <br /> <br />Date: <br /> <br />Issued by: <br /> <br /> FEE; SCHEDUL~ (Complete lind ~nte¢ total ia Al bolow) <br /> <br /> RI~SIDBNTIAL ~ COMIdERCIAL [2 <br />USIi OF STRUCTURtt: <br />NEW 72 ALTERATION [3 ADDITION m RELOCATION <br /> <br />BASE FEE $20,110 <br /> <br />m~ximum ors00 ft,) $15.00 <br /> <br />$~5,00 <br /> <br />$30.00 -- <br />$ tS.00 -- <br /> <br />PROTBC'r IVE BACKFLOW D~rlCE <br />Lawn vacumn breaker ($pfi~lgr ayatem)~ $ 4,50 <br />All o~e~ $10,00 <br /> <br />OTHER (as mquiredby O~P~ <br /> <br />DWBLLINO PEmlTL~ ~ofht~qs <br /> <br />s. <br /> <br /> A2. Ad~ <br /> <br /> <br />