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Application Received <br />Date <br /> <br />Application Approved ~I <br /> <br /> Marion County <br /> <br />DEPT, OF BUILDING INSPECTION <br />COURT HOUSE, EALEM. OREGON <br />588-5147 <br /> <br />APPLICATION FOR PLUMBING PERMIT <br /> <br />Bidg, Permit <br /> <br />Permit Fee <br />Surcharge <br />Receipt ~_ <br /> <br />NOTE: Applicants must hold Oregon Registration to conduct a plumbing business ~ or must be property owner/operator not <br /> hiring outside help [~]. Indicate statue. <br /> <br />Job Address <br /> <br />IPLUMEING <br /> EUSINESS <br />LICENSE NO, <br /> <br />TYPE OF PERMIT <br /> <br />NO. OF ITEMS FEE ON EACH TOTAL <br /> <br />Base Price <br />Residential <br /> Kitchen Unit <br /> <br /> Bath Unit (full) <br /> Bath Unlt (half) <br /> Laundry Unit <br /> Miscellaneous Fixtures <br />Commercial <br /> 1 to 50 Fixtures <br />Over 50 Fixtures <br />Alterations & Additions <br /> <br /> Charged a_ t Commercial Rates <br />Lawn Sprinkling System <br /> <br />To and including each protective device <br /> <br />$4.00 <br />$~.00 <br />$3.00 .. <br />$3.00' <br />$2.00 <br /> <br />$2,00 ea. <br />$1.00 ea. <br /> <br />TOTAL AMOUNT AffL 'iYE'Ms <br />SURCHARGE ~¢~ %`` <br /> <br />GRAND TOTAL <br /> <br />$ 5.00 <br /> <br />I certify that all plumbing work will be done in acco~danca with .appica~pr~v~i~io~$ of Oregon Revised Statutes <br />and 693 and app cab e codes and tbat no he p w be emp oyed un ess censed un~e~.~l~S~ 693 <br /> . .... <br />....................................................... ~;~-b-f ~7[~-~b7 .............................................................. f ....... ~-'-~ .................... <br /> Return ~m~le~ Appli~tion With the Indim~d Fe¢~" · . <br /> <br /> <br />