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FOR CITyJJ~E ONLY <br />Received'By:. Date: <br />Zoning By: City: <br />P~eeipt #:__ Amount: $ <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305 <br />8:00 am - 4:30 pm 24 hr. Inspection Ume 373-4427 FAX 588-7948 <br /> <br /> PLUMBING PERMIT APPLICATION <br /> Please complete all Sectlons, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />parcel ID: <br /> <br />[P~ Ar. r lvo~-riv~vsrre. Al~ A~ lixinlrltr lr ~/o~c~ ] <br /> IS ArOT STARTED RffI'HIN I$O DAI~ OF I~UANCE OR IF <br /> WORK I$ SUSPENDED FOR 188 DA I~. <br /> <br />CONTRACTOR INFORMATION <br /> <br />Phtmbe~s License: <br /> <br />Journeyman Pi~ing License: <br /> <br />Regisiration Numbe~. <br /> <br />Propeay O~mer~ <br />~ em: ~ z~: <br /> <br />Owner's $ignatorc: <br />Agent's $ignatore: ~ <br /> <br />4. FEE SCHEDULE (Comldege and enter totalin ~-AI below) <br /> <br /> ( ) RESIDENTIAL ,~OMMERCIAL ( ) OAS ( ) ELECTRIC <br /> <br />~,~EW ( )ADDITION ( ) ALTERATION ( )RELOCATION <br />Fixtures (New / Altera~on) OTY. QTY. <br /> <br /> Backflow Prevention Device __ Laundry Tub <br /> <br /> Ca/~h Basin -- 'Sink <br /> Clo~e~ W~her ~ Trough Drain -- <br /> <br /> Drafting Fountain / Wmr ¢losa <br /> <br /> Total#Fixtures: ,/~ x $15.00 = $,.~-~'~"-] <br /> Reconnec't(perfixture) x $7.50 = $__ <br /> <br />SanBarv Sewer L~es <br />Resldential:~ltatl00fc, or fi-action thereof __ x $3&00 = $ <br /> Foreaaddoll00iLupto500f~et __ x $16.00 = $ <br />Comm~ial:Firall00fl.,orfractionlbemof /O~ x I35.00 <br /> Foreaaddnll00feet x $20.00 =$ <br /> <br />Storm Drains <br />P,~identiahFir~tl00fL, orfiaetiontbe~of __ x $35.00 = $ <br /> Foreaaddall00B, uptoS00feet __ x $16.00 = $ <br />CommeveiakFirstl001~,orfrac6ontbereof __ x $35.00 = $ <br /> Foreaaddn1100feet x $20.00 = $ <br /> <br />Minor InstaflaBon Labels <br />Pa~k of 10 labels ~ $10.00 eact~ <br /> sold only to Plumbing ¢onlractors) <br /> <br />x $10.00 =$ <br /> <br />Dwelllag Permit Labels <br />(For New Single Family Dwellings Only) <br /> <br />#of Labels <br /> <br />One/~vo Family Dwe~ Fee Squar~ <br /> <br />Other (as required by the Building Oft-wi,al) <br /> <br />x $ .09 = $ <br /> <br />$. FEES <br />Al. BA~E FEE Axse~ed on/~L APPLICATIONS: <br /> <br /> minimum one hour) $ __ <br /> <br />$ t ?,~-~ <br /> <br /> <br />