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• <br /> r • <br /> INARION COUNTY BUILDING INSPECTION <br /> Received By: - I Senator 5Idg.No.2:.5 <br /> ide�G jj �/�-�n22a High Skeet NE <br /> Date; rY� 0/24 iv <br /> '4 Salem,ho Oregon <br /> y,l ,� yY Code-A-Phone4:30 PM.-8:00 A.M. ' <br /> r <br /> v`n ,iii • <br /> �1 �d if 1' 1/111 G PERMIT APPLICATION <br /> . <br /> Owner: - tj) <br /> Address: <br /> ' )El y+.. i QQ•- 72 � 4,4 _4to, 0aa,, 1.3, 74,,, <br /> Situs Address: ... Ii e-No.: Cross Street: <br /> / 'D 1 .-C4 4 a4, U ►.f" w�. <br /> Plumbing Installer. 1 Phone: Address: <br /> Home Builder's Re Istra�o.: -.. • <br /> .._ <br /> 9 <br /> • <br /> Residential: Llen - New: ti9.. Addition: O Occupancy Use of Building: <br /> Commercial: 0 It+ti it Alteration; 0 Relocation: ❑ Change: 0 <br /> NO. FEE AMOUNT <br /> Base Price $10.00 <br /> Residential <br /> New construction(each fixture) $ 7.50 <br /> Alterations(each fixture) • 7.50 _ <br /> Re-located Residence(each fixture) • . 3_75 <br /> Commercial - y <br /> New Construction(each fixture) i 7.50 ' <br /> Alterations(ego fixture) 7.50 <br /> Water Lines __ _ <br /> For the first 100 feat or fraction thereof _ 20.00 <br /> For addifional.100 feet 15.00 ' <br /> Sewer Service Lines <br /> . First 100feetor fraction thereof _ 30.00 <br /> J• Additional 100 feet • ' 15.00 <br /> Lawn Sprinkling System _ ' <br /> To and including each protective device 5.00 <br /> - Other(as per OSPSO and Building Official) • <br /> On-Site Technical Review(apply at Marlon County only) . <br /> Re-Inspection Fee <br /> FEE $ 6.1-') tf'V y, <br /> STATE SURCHARGE Y , A <br /> 'PLAN REVIEW FEE $ r— <br /> ' DOUBLE FEE $ �^ <br /> Please return COMPLETE APPLICATION FLEET SURCHARGE $ • . 5.4 6 <br /> with the indicated fee. CITY FEE $- -__ .. , ;c 0 4,/' <br /> TOTAL $ ' 3 KA 7I <br /> v' <br /> ( ..ki lam performing work on a property I own or occupy. S <br /> ( ) I am a registered builder OR( )the authorized representative of SIGNATURE OF APPLICANT: <br /> • a registered builder- • <br /> ( ) The work will be performed by a registered builder. 'A . <br /> ( ) Other • . <br /> ( py I agree to Install according to the submitted plans and specifications,the laws of the elate of Qreggn and the ordinances of Marion County. <br /> MC 1545 . <br /> Rev,3/B7 <br />