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.~PIgr~ng Permit Application MARION COUNTY Plumbing Permit Application <br /> DEPT. OF:tBUILDING INSPECTION <br /> ::,-S~nater Building # 225 <br />Appl. Recd: . ' 220 H gh St. N,E. 2nd Floor Bldg. Permit NO. 78-2494 <br /> ~" ' Sa em, Oregon 97301 <br /> By: :, ~-'R,H. WLTHROW, BLDG. ADMINISTRATOR <br /> <br />Date: <br /> <br />~/~,' 588-5147 58S-§148 <br />5:00 P.M.- ............ CODE-A-Phone 588-5373 ............. 3:00 A.M. Date: <br /> <br />Type of Permit: <br /> <br />PLUMBING <br /> <br />Address: 10153 HILL CREEK RD SE AUMSVILLE <br /> <br />O ~rFULL GOSPEL TABERNACLE <br />wn~ :__, Phone:. <br /> <br />Bldr.& No.: SAME Phone: . <br /> <br /> Tax Lot NO:. <br /> .Sec. Twnshp, <br />Address;.. <br />Address: . <br /> <br />Rge __ <br /> <br />Plbg, Installer. SAME Address. ,Phone <br /> <br /> TYPE OF PERMIT NO. OF ITEMS FEE ON EACH TOTAL AMOUNT <br /> Base Price .,, $10.00 <br /> Residential <br /> Kitchen Unit' ' includes Water He~ter " <br /> Bath Unit (fall) .. 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 ....... 6 5:00 ea. 30.00 <br /> Over 50 Fixtures 3.00 ea. <br /> Alters. ti?ns & Additions , ,.. ' <br /> Charged st Commercial Rates <br /> Lawn:Spt ek ng System ' ' <br /> TO and including each protect ye day ce 5.00 ' <br /> FEE' 40,00 <br /> Please return c~mPlete application SURCHAI~GE <br /> with the indicated fee. 1.60 <br /> ' TOTAL ' <br /> <br /> · . 41.60 <br /> <br />I.agree to perform work according to the submitted· plans and specifications, the laws of the State of Oregon and <br />the Ordlna~ gas 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 license0 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 /> <br />