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R~eived by:. <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE - Room 13:2 <br /> Salem, OR 97301 <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATIOH OF INSTALLATION <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone 588-5147 8:00am = 4:30pm <br />FAX: 588-7948 <br /> <br />Job Descri?tion: <br /> <br />pERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT [ <br /> STAk'i~D WITHIN 1~0 DAYS OF ISSUANCE OR IF <br /> <br />P.A. CONTRACTOR INSTALLATION ONLY <br />Contractor I Phone <br /> <br />Mailing Address <br /> <br />Contractor's Board Re;. No,,.~'~ ~.~---- I [ loiNo, <br /> <br />2.8. FOR OgrN'BR INSTALLATIONS <br />Properly Owner (pleaso prim) <br /> <br />Mailing Address I Phone <br />City/Stats'Zip <br /> <br />Owner's Signature: <br /> <br /> , <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 15-45 <br />Rev. 1/96 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEB SCHHDULE (Complete mad en~r total in A1 below) ~t <br /> <br /> RF~IDENTIAL ~ COMMERCIAL ~ <br /> USE OF STRUCTURE: <br /> NEW/2 ALTERATION C2 ADDITION ~ RELOCATION <br /> <br /> ~ X Fee = Sam <br />BASE. FEE $20.00 <br /> <br />RESIDENTIAL (each fvitute) <br /> Amora Dwelling Plumbing Fee ___sq. fl. x $.070 ~ <br /> <br />Kmgle Family or mulli-famil~ per <br />dwelling unit -7~ <br />New construction $10.00 <br /> Alterations $10.00 <br /> Reconnect $ 5.00 <br /> <br /> maximum of 500 fl,) $ I5.00 -- <br /> maximum orS00 ft.) $15.00 -- <br /> <br /> $15.00 <br /> <br /> $15.00 <br /> <br />5. FEES <br />A 1, E~ter total of fees from Sec. #4 $ <br />A2. Add 5% st~harge (,05 x Al) $__ <br />Sabt~al <br /> <br /> B. Enter 25% of lin~ Al for Plan R~vicw <br /> (Al + .25), if required <br /> C. Investigation Fee (ifmquirod) $__ <br /> D. Reinspection Fee ($25.00) $__ <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No, <br /> <br /> <br />