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COMMUNITY DEVELOPMENT CENTER <br />R~,iv~d b~.: / ~ W ~.tt'-'or~ Salem, O~ 973m <br /> <br /> F~: 58~948 <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all 8ectlone, I through <br /> <br />1. LOCATION. OF INSTALLATION' <br /> <br /> PF~MIT8 AP~ NON-TRAN$1~RABUi ~ ~ ~ WO~ <br /> ~ ~ lffi DAYS OF ISSU~ OR <br /> WO~ IS SUS~ ~R I~ DAYS. <br /> <br />2B. NOR OWNBR INffrALLATION8 <br /> <br />Ptop~ty Owner ;pleaso pri~) <br />Mailing Address I Phone <br />City/Slate/Zip <br />Owner's Signature: <br /> <br />Agent's Signatm~: <br /> <br />4. ~B ~I'L~L}Ov-~B (Cc~nplet~ and enter totnlinAl below) <br /> <br /> RBSIDBNTIAL [] COMMBRCIAL n <br /> USE OB ~TRUCTURB: <br /> NEW ~l ALTERATION ~l ADDITION ~ REI~CATION O <br /> <br /> BASE FEB <br />i~RESIDENTLAL (each ftxmre) <br /> Aurora Dwelling Plumbing Fee <br /> <br /> · Sinile Fnmil y- 6r n~ultl.fan~il~, per <br /> dwelling unit <br /> New construction <br /> Alteratiom <br /> Reconnect <br /> Relocated Struoture <br /> Modular Structure <br /> <br /> Water Line~ <br /> First 100 fl. or fraction thereof <br /> For ea. addul' 100 ft. (up to <br /> m~ximum of 500 ft.) <br /> <br /> Sauilary & St<mn Lines <br /> Fimt 100 fi. or fraction thereof <br /> For addul' 100 fi. (up to <br /> maximum of SO0 ft.) <br /> <br /> COMMBRCIAL (eaCh fixture) <br /> <br /> Water Line~ <br /> First 100 fl. or fraction thereof <br /> For e~ addnl' 100 fl. <br /> <br />Fee = 8urn <br /> $20.OO <br /> <br />._sq. ft. x 5.070 = <br /> <br />$10.00 · <br />$10.00 <br /> 5.00 <br /> 5.oo <br /> 5.00 __ <br /> <br />$15.00 <br /> <br />$3O.OO <br /> <br />$15.00 <br /> <br />$I0.00 <br />$10.OO <br />$10.OO <br /> <br />$~5.00 <br /> <br />$15.00 <br /> <br />Sanitary & Storm Line~ <br />First 100 IL or frncfion thereof $30.00 <br />For sddal' IOO ft. <br /> <br />$15.00 <br /> <br />PROTECTIVE BACK,LOW DEVICE <br />Lawn vacuum breaker (st~i~kler system) $ 4.50 <br />Ail others $10.00 <br /> <br />OTHER (as mquSred byO~PSC <br /> and Buil&'~g O~i¢iaO <br /> <br />DWELLING PERMIT LABEL # of Labeb N/C <br /> <br />3. PLAN RBVIBW SECTION <br /> <br />Marion County does not require a plan review. <br />We will pwvide 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 />5. FEES <br /> Al. Enter total of fees fwm <br /> A2. Add 5% sorchar~ (.05 x A l) <br /> $ <br /> <br /> B. ~t~25% ofl~cA1 for Pl~ <br /> (Al + .25), if ~qu~ <br /> C. ~vesfigafion FOe (if~q~d) <br /> D. ~peet~ ~ ($25.~) <br /> <br /> TOT~ ~O~ D~ $.~ <br /> R~ei~ No. <br /> <br /> <br />