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COMMUNITY DEVELOPMENT CENTER <br />FOR C .......... I 285 Chinch S1 NE · Room 132 PEPJ~IIT NO: <br /> 1 1' I YPd~IUA'I'IUIN Salem, OR 97301 <br />R~ei~ b~ [ Date: <br /> <br /> I ~I ~r~p~on Line 373~27 [ ~ ~ <br /> <br />PLUMBINa APPLICATION 0 I . <br /> <br />PERMITS A RE NON-TRANSFER.ABLE AND EXI~IRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />l~,pecty Owner (p&as~ pnnt) <br /> <br />Phone <br /> <br />Reconnect $ 5.00 <br />Relocaled Straclure $ 5.00 <br />Modular SLruc tun: $ 5.00 <br /> <br />maximum orS00 fl.) <br />nmximum of 500 fi.) <br /> <br />s o.oo <br /> <br />$15.00 <br /> <br />$30.00 <br /> <br />$15.00 <br /> <br />S10.00 <br />S10.00 <br />$10.00 <br /> <br />First 1(30 fl. or fraction thereof <br />For ca. addnl' <br /> <br />$25.00 <br /> <br />$15.00 <br /> <br />Samtaty & Storm Linea <br /> Fir~! IOO fl'. or ~¢tion thereof <br /> For addnl' 100 fl. <br /> <br />$30.00 <br /> <br />Sl5.00 <br /> <br />PROTECTIVE BACKFLOW DEVICE <br /> <br />S4.50 <br />$10.00 <br /> <br />OTHER (as requtrodbyOSP$C <br /> and Building O~cieD <br /> <br />DWELLINO PERMIT LABEL //of Lnbels <br /> <br />3. PLAN REVIEW 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 15.45 <br />Rev. I;96 <br /> <br />5. FEES <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ /,~o <br /> <br />$ <br />$ <br />$ <br /> <br /> <br />