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FOR CFFY U.<i£ ONLY <br /> Pu:~/vcd By:. Date: <br /> ~ By: <br /> R~:elp~ #: Amount: $ <br /> <br /> PLUMBING PERM IT APPLICATION <br /> Please complete all Sections, l through <br /> <br />I. LOCATION O£ INSTALLA'flON <br /> <br />2A. COHTRACrOR INFO R34ATION <br /> <br />211. FOR OWNER INSTALL&TION <br /> <br />c~ <br /> <br /> 3150 Lancaster Dr. NE - Suite C <br />S::,lem, Or, goo 97305 <br />$:00 am - 4:30 pm 24 hr. I~spection Linc 373-4427 FAX555-?948 <br /> <br />P <br /> <br /> FEE SClIEDULE (Complete oscl cuter ~otal iu S-A1 bcDw) <br />( ) R~SiDENTLAL ( )CO~RCI~ ( )G~ ( )EL~CT~c <br /> <br /> )NEW ( )ADDITION ( ) AI.TERATION ( )~L~AT[ON <br /> <br />Backflow Pr~,cmkm Dcv{~ <br /> <br />Bida <br /> <br />Clo~ Washer <br /> <br />Eusp/~r <br /> <br />R~o~ ~ ~urc) <br /> <br />~h~ Vacuum Br~k~ <br /> <br /> QTY.. Q'FY. <br />....... Laun~ 'rub <br /> <br />-- 'l'mugh Dr~ <br /> <br />7,50 <br />7.50 <br />$10.00 <br /> <br />-L x $2f00 - $ ..... <br /> x $i6.00 = s <br /> x 530.00 - $ <br /> × s20:00 =$ <br /> <br />R~sidcntJal: Fu~ lO0 1~, or ~on ~zz:af x $35.00 - $ <br /> For~l~uptoS~ ..... x $16.00 = <br />Cmum~c~l:Fi~ 100~,oe~ion~f x $35.00 =$ <br /> For~ad~100~r x 520.00 =$ <br /> <br /> For m ad~ 100 ~ up to 500 ~ x <br />~al:Fi~ I00 ~, or ~ion ~c~f ~ x <br /> F~ ad~ i00 f~ x <br /> <br />Pack afl0 b.b:k <br /> <br />~ New Sin~c F~)' D~¢[I~ Oaly) <br /> <br />0~ (us ~u~ ~, ~= Bui[d~g OGci~l) <br /> <br /> $35.00 - $ <br /> $16.00 = $ <br /> $35.00 - $ <br /> $20.00 = $ .... <br /> <br />-- x $10.00 =5 <br /> <br />x $ .0~ - $ 5 <br /> <br />5. FEES <br /> <br />S UBT O'I',%L ~ ...... <br /> <br />E. Additional Plat Rcviexv (i6Z.S0/hour. mini. mum one halfhou0 $ -- <br />G. Ins~:,:t/o~ Outside Nct, xlu[ Bus/ness Hms¢; (562,50/hr, <br /> <br /> <br />