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FOR CITY VALIDATION Received by.' Date: MARION COUNTY BUILDING INSPECTION COMMUNITY DEVELOPMENT CENTER 285 Church St NE · Room 132 Salem, OR 97301 24 Hr lnsp~tion Lin~ 588-7904 OflT~ 588-5147 8:00mm.-4:30p.m. PERMIT NO: Date: Issued by: FAX: 588-7948 PLUMBING PERMIT APPLICATION~t~'~(-~.~I[ ~m~ I. LOCATION OF ~~ON ~ SEP 29 19~ssov~ucTms: NEW ~bA,~ ~ 10 ctrt,~ ~ MARION o~ ~~ I c~sL BUILDING ~S AP~ NON-TRANSFERABLE AND~IRE IF WORK lS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPI~IDED FOR 180 DAYS. 2A. CONTRACTOR INff~ALLATION ONLY 2B. FOR OW~TI~. INSTALLATIONS l~oinay Ow~ Mailing Address i ~o~e City/State/Zip Owner's Signature: Agent's Signature: 3. PLAN REVIEW SECTION Marion County does not require a plan review. We will provide plan review service if you complete Section 5B and submit two (2) sets of plans and specifications with this application. MC 1545 Rev. 12/94 JNTY 'E~ RESIDENTIAL (each fmmre) A~a*ora Dwelling Plumbing Single Family or multi-family per dwelling unit New construction Alt~rimons Reconnect maximum of S00 ft.) F~ addnl' 100 fL (up to __sq. ft. x $.065 = -- $10.00 -- $10.00 $ 5.00 __ $ S.00 __ $ 5.O0 __ $20.00 -- $15.00 -- $30.00 -- $15.00 -- $10.00 -- $10.00 -- $10.00 __ $25.00 -- $15.00 -- $15.00 -- $ 4.50 $,o.oo #ofL~bels NIC 5. FEES Al. Eater total of fees from Sec. #4 A2. Add 5% aureharge (.05 x Al) Subtotal B. Enter 25% of line Al for Plan Review (Al + .25), if required C. Investigation Fee (if required) D. Reinapeation Fee ($25.00) TOTAL AMOUNT DUE Receipt No.