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Applibation Received <br /> <br />Date,//--///-/ <br /> <br />Appl[ceti° n Ad~aF'>~ <br />Data <br /> <br />DEPT. OF BUILDING INSPECTION <br /> <br /> , 3180 CENTER STREET N E <br /> SALEM OREGON 97301 <br /> 588-5147 <br /> <br />APPLICATION FOR PLUMBING PERMIT <br /> <br />NOTE: Applicants must hold Oregon Registration,,to':'c0ndu,ct a ,plumbing ,business I~ or must be property owner/operator not <br /> <br />hiring outside' heJp C'L Indicate status. <br /> <br />PLUMBING <br />BU$1NE~ <br />LICENSE NO,, <br /> <br /> HOME BUI LDE RS <br />I F{E, GISTRATION NO,, - ................ <br /> <br />Owner 4~// ~L,~/J Address· <br />Plbg, Installer ~- Address. <br /> <br />Phone <br /> <br />Phone <br /> <br /> TYPE OF PERMIT NO. OF ITEMS FEE ON EACH TOTAL <br /> .. , -, - $ <br />Residential <br /> Kitchen L~,r~!t.,, Includes Water Heater ......... / $4,00 . <br /> Seth Unit (full) .... 3 $5.(~0 <br /> Bath Unit (h~lf) $3,00 <br /> <br />Sewer Service Line ~ ~ ', ,'.- , ,: '~. $3 O0 <br />With Plumbing Turn-a~ound .... , .... .', ?, , ' ..... - ' $5.00 <br />Alterations & Additions : , , '. , <br />Charged at Com.m. ercial Rates ......... . '"' ~ ~ . <br />Lawn S. pr!~kl,ing System ' ' <br /> To and includln[I e_ac.h protective device $2.00 <br /> TOTAL AMOUNT ALL ITEMS <br /> · , SURCHARGE <br /> GRAND TOTAL <br /> <br />I certify that all plumbing 'work wi!l ~be~dpne il~ ,a~a~,..ce ,~i~,~pp!jca~blB,,provjsions of Oregon Revised Statutes ChSpte~s ~7 <br />and &g3 and appli~ble ~des, and t~at no ~e p "" ~'~'~ ":' ''~ '~' ~ ' <br /> wdl be employ~ unless hcen~ under O~S <br /> <br />............... ................................................... <br /> Return ~mpl~ Appli~fion With the Ip~ia~d Fee. <br /> <br /> <br />