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I PLUMBING PER.MIT APPLICATION <br /> Ptease complete all $~n~, I througk <br /> <br />1. LOCATION OF IiNSTA! ! ATION <br /> <br />IS NO'J'STARI'~.D ~.tlI-II, I~ I,gO DAYS OFI~SI.M~CE OItlF . <br />FYOIt~ 1S SUSPEi~KD FOR 1.,~0 <br /> <br />z~: 97309 <br /> <br />Cc~tr~tom Beard <br /> <br />2~CONTRACTORINFORMATIO~ <br /> co.~. Judson's Inc. <br /> ~ P.O. Box12669 <br /> <br /> ci~Salem stat=OR <br /> mo~:(503) 363=4141 <br /> <br /> (503) 399-8760 <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br /> Mailing Addre~ <br /> City: Sa~ Zip: <br /> <br /> I am t~e PROP~RT~OF/NEB and I resMe in. or will reside in t~e completed <br /> stt-act~re and will be my own general controctor. [ tmdet~tond that ! mtt~t <br /> register a~ a con~trucaon contractor if the Jtr~ctare i~ ~oid or offered for sale <br /> before or upon completion. If l here ;ubcontractor$, I will h~re <br /> subcontractors r~gi~tered with the Co,,m'~t~on Contractoes ~oar~ Ill <br /> change my mind and do hire a general contractor who i~ registered ~th the <br /> Conxtr~ction Contractors Board. I will immediately noff/y Ma~on County of <br /> the name of the contractor: <br /> <br />Owner's Signatu~: <br />Ag~at's Signature: <br /> <br />FEES <br /> <br />B,4,.qE FE£Jssts~,d onA].L,4PPLIC~TIONS: $ 25.00 <br /> (~: Wa~ L~ ~1~ w/~ ~ <br /> <br />Al. ~ F~~ <br /> <br /> S~TOT~: <br /> <br />C. lnv~i~ti~ P~ if~u~ $ ~ <br />D. R~on P~ ($~0.~) S ~ <br /> <br /> m~imum ~ ~0 <br /> <br /> $ <br /> <br /> <br />