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FOR CITY U~E ONLY <br />Rec~l~ed By: Date: <br />Zoning By: City: <br />Receipt #: Amount: <br /> <br /> PLUMBING PERMIT APPLICATION <br /> Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION q~ ~'0~ 0l ~'~ <br />Parcel ID: <br /> <br />Site Address: <br /> <br />Project Description: <br /> <br />PERMITS APE NON- TRANSFERABLE AND EXPIRE IF WORK <br />IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INFORMATION <br /> <br />Fax: <br /> <br />FOR OWNER INSTALLAIION <br /> <br />Progeny Owner: (please print) <br />Mailing Address: <br />City: State: Zip: <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside in <br />the completed structure and will be my own general contractor. I <br />understand that I must register as a construction contractor if the <br />structure is sold or offered for sale before or upon completin~ If l <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Board. If I change my mind and do <br />hire a general contractor who is r~gistered with the Construction <br />Contractors Board. I will immediately notify Marion County of the <br />name of the contractor. <br /> <br /> Agent's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County doc~ not require a plan review. We will pwvide plan <br />review service if you complete Section 5B and submit two (2) sets of <br />p aris and specifications with this application. <br /> <br />MC 15~.5 Rev 9/98 <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 3150 Lancaster Dr. NE - Suite C <br />Salem, Oregon 97305 <br />8:00am - 4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 <br /> <br /> 4. FEE SCHEDULE (ccmplete and enter total in S-A1 below) <br /> $1DENTLL ( ) COMMERCIAL ( ) GAS ( ) <br /> FA~CrRIC <br /> <br /> · ( )NEW ( )ADDITION ~TION <br /> ( <br /> ) P~LOCATION <br /> <br />Fixtures (New / Alteration) <br />Area Drain <br />Backflow Prevention Device <br />Bathtub <br />Bidet <br />Catch Basin <br />Clothes Washer <br /> <br />ResideetJak First 100 f~., or fraction tlmeof -- x $35.00 = $__ <br /> For ca addn1100 iL up to 500 ft x $16.00 = $__ <br />Conm~rcial:]~rstl00fl.,offrac~onthe~of -- x $35.00--$ <br /> F~eaaddnll00feet -- x $20.00=$ <br /> <br />EASE FEE Assessed on ALL APPLICATIONS: <br />(Exception; Water/Sever Linc Applications wh~o fixings) <br /> <br /> Al. Enter total of fees from Section <br /> A2. Add $~a~ Su~harge (.05% x Al + Base F~) <br /> <br /> B. Enter 30% of line Al for Pinn Review . <br /> <br /> E. Additional Plan R~vlew ($62.50/hr, <br /> rain/mum one-half hour) //~ <br /> <br /> TOTAL AMOUNT DUE <br /> <br />25.OO <br /> <br /> <br />