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FOl~C~lTstr ~US~ ONLY <br /> Received By: _Dale: <br /> Zoning By: City; <br /> Receipt ~ Amount: <br /> <br /> PLUMBING PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> ?at~l ID: <br /> <br /> City: h *0 ~'~,~'0 "1 l l0J <br /> <br />PEI~IITS ARE NON.TRANSFERABLE AND EXPIPJ~ IF WORK <br /> <br />IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WOR~ IS SUSPENDED FOR 180 DAYS. <br /> <br />Mailing AdOress: <br />City: State: <br /> <br />Zip: <br /> <br />PlumbemLice~e: <br /> <br />Con~aetor~Board <br />Registration Number: <br /> <br />Contractor's Signatute: <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br /> I ~ t~ PROP~ OWNER a~ own, ~side i~ or will ~si~ ~ <br /> s~mm is soM or offemd~r s~ ~om or ~n eo~lefion, ff l <br /> <br />Agent's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> Marlou Coun~ does not ~equlre a plan review. We wilt provide plait { <br /> review service if you complete Section 5B and submit two (2) sets of <br /> plans and spec ficafions with this applicat on. <br /> <br />MC 1545 Rev 9/98 <br /> <br /> 3150 Lancaster Dr. NE ~ Suite C <br /> Salem, Oregon 97305 <br />8:00am - 4:30pm 24 HR Inspection Line 3734427 FAX 588-7948 <br /> <br />4. FEE SCHEDULE (complete and enter to~d in S-A1 below) <br /> <br />( ) RESIDENTIAL ( ) COIVlI~=RCIAL <br />( )NEW (~ADDmON <br />Fiztur~ (New / Alteration) <br />Area Dmin <br /> <br />Wa~r~Inra <br /> <br />GAS ( ) ELECTRIC <br />ALTERA~ON ( ) P, ELOCAHON <br /> <br />Minor Installation Labels <br />Pack of 10 labels @ $10.00 each, <br /> sold only to Plumbing contractors) <br /> <br />Trough Drain -- <br />Tub/Shower <br />Urinal <br />Water Closet <br />Water Heater <br />Other <br /> <br />x $15.00=$__4 <br />x $7.50=$__ <br />x $7.50=$__1 <br />x $10.00 = $ <br /> <br />$~5.00 = $__2 <br />$16.00=$__ <br />$30.00 = $__ <br />$20.00--$__ <br /> <br />$35.00= $__2 <br />$16.00= $__ <br />$35.00= $__ <br />$2~.00= $__ <br /> <br />$35.~0 = $ -- 2 <br />$16.00 = $ -- <br />$35.00 = $ -- <br />$20.00=$__ <br /> <br />__ x $10.00=$__ <br /> <br />~f Labels __@ $ N/C <br /> <br /> x $ .09 = $__ <br /> <br /> $__ <br /> <br />$ <br /> <br />$__ <br />$__ <br />$ <br /> <br />B. Enter 30% of line Al for Plan Review <br />C. Investigation Fee (if required) <br />D. Reinspeetion Fee ($50.00) <br />E. Additional Plan l~view ($62.50/hr, <br />minimum one-hal~ hour) $ -- <br />E Inspection for which no fee is specifically indicated, <br />($62.50/hr, min~mttm one hour) $ -- <br />G. Inspection Outside Normal Business Hours, <br />($6230/hr, mi~mmn two hours) <br /> <br /> <br />