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Plumbing Permit Application MARION COUNTY ' Plumbing Permit Applicati6,n <br /> DEPT. OF BUILDING INSPECTION <br /> senator Building # 22§ ~'-~_~ ,..~ <br />Appl. Re, cd:: 220 High St., N.E. 2nd Floor Bldg. Permit No. <br /> . Salem, Oregon 97301 <br />~y?. R.H. WITHROW, BL~. A~INISTRATOE PIbg.. Permit No. <br /> ~ 588-5147 -- 588-5148 _ <br /> <br />Type of Permit: P~ ~//"~/~ /,..C/,;;::~ Tax Lot No: ........ <br />Address:.,,,,,,/~'~ ~ ~ ~'~'~'~ ~ ~ ~ .......... Sec., Twnshp,, <br /> <br />Owner: Phone:. Address: <br /> <br />Rue __ <br /> <br />Bldr. & No..::. Phone:. Address: . <br /> <br /> TYPE OF PERMIT NO, OF ITEMS FEE ON EACH TOTAL AMOUNT <br /> Base Price $10.00 <br /> Residential <br /> Kitchen Un"it In.cl.~dea Water R'~ater .... ' ............. $..1.~.~.00 <br /> Bath Unit (full) ........................ 10.00 <br /> Bath Unit (half) 5,00 <br />Laundry Unit ' ..... 5.00 <br />ui$cellanec!~,~ Fixtures ................... 5.00 ....... <br />Sewer Service Line <br />Private - Shall be char~d per 100':or fraction thereof 10.00" <br />....... Commercial I' ' <br />1 to 50 Fi'x{ures ....... <br />Over 50 Fixtures 3.00 ea. <br />Alterations & Additions ..... <br /> Ch~'~'ge~. at Commercial"Rates ............. <br /> Lawn Sprinklin~ ,System ..... <br /> To and Including.each protectlv~'devic.?_ 5.00 ..... <br /> <br /> Please retul~n complete appIIcat on SuRcHARGE <br /> with the indicate{:l fee ~ ~'~ <br /> TOTAL <br /> <br />I agree, to perform work according to the:submitted plans and specifications, the .laws of the State of Oregon and <br />the Ordinances of Marion County. Permit expires if work not commenced w th n 120 days I further expressly war- <br />rant that I comply with the provisions of ORS 701.005 tO 701:125 because: <br /> <br />I am a registered and licensed plumber or <br />The authorized representative of a registered and licensed plumbing contractor. <br /> <br />( ) The work will be performed by a registered and licensed plumber <br />( ) I am performing work on a property I own or occupy <br />( ) Other (please specify') <br /> <br />SIGNATURE OF APPLICANT-. <br /> <br /> <br />