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FOR CITY VALIDATION <br /> <br /> MARION COUNTY <br />BUILDING INSPEC'I'ION DM$ION <br />M 50 La~c~ Or. HE - Su't~ C <br /> S~lem, O~gon 97305-1398 <br /> <br />24 HR Inspe~ion Line 3?3-4427 <br />~ pb~ 3~-Si47 S:~tm - 4:~pm <br />FAX 58~7948 <br /> <br />PERMIT NO: <br />Date: <br /> <br /> PLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> ~S S~T~O~ <br /> <br /> P~ ~ ~0~S~LE ~ E~I~ IF W0~ IS NOT <br /> ST~ ~ i~ DAYS OF ISSU~ OR ~F <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />plombing C~r~or <br />~ Cit~ <br /> <br />~m~.A~ONNO. I, I I I <br />~R'S SIONA~ <br /> <br />III <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Mailing Addle--ss <br /> <br />Ovn~r's Signatu~ <br /> <br />~ OTY OTY <br />AREA DRAIN INTERCEPTOR <br />BACKFLOW PREV DEVICE LAUNDRY TUB <br />BATHTUB ~ RECEPTOR <br />BIDET SHOW-~!R <br />CATCH BASIN SINK <br />~ WA~HBR IROUOH DRAIN -- <br />DENTAL UNIT TUB/SHOWER <br />CUSPIDOR URINAL <br />DRINKING FOUNTAIN WATER CLOSET <br /> ! <br />FLOOR DRAIN WAI-~R <br />OTHER WET BAR <br /> Tolal # Fixlm~ 5'~'x $10.00 <br /> <br />5. FEES <br /> <br /> A2. Add $% sm'c~m~e (.0S x Al) <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County docs not require a plan ~'evicw. <br /> We will provide plan review service if you complete <br /> Section SB and submit two (2) set~ of plans and <br /> specifications with this application. <br /> <br /> (Al + ,2s), if m:lulm:l <br />C. lnve~igmioo Fee <br />D, Reimpe~ion Fee ($25.00) <br /> <br />Receip~ No. <br /> <br />MC 15-45 <br /> <br /> <br />