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Plumbing Permit Application
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<br />Appl,, Recd:: ,, ,
<br />
<br /> MARION COUNTY
<br />DEPT. OF BUILDING INSPECTION
<br />Senator Building # 225
<br />220 High St,,, N.E,, 2nd Floor
<br />
<br /> Plu mb! n~g_ Permit Application
<br />Bldg. Permit/No, (~)~'-0 -~:fU~/
<br />
<br /> Salem, Oregon 97301
<br />By:: R.H. WITHROW, BLDG. ADMINISTRATOR Plbg,, Permit No
<br /> 1~::~.._~7.~ 588-5147- 588-5148
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<br />Bldr,, & No,,:: Phone:: Address::.
<br />
<br />Phon~~~-~
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<br /> TYPE OF PERMIT NO. OF ITEMS FEE ON EACH TOTAL AMOUNT
<br /> Base Price $10.00
<br /> Residential
<br /> Kttchen Unii" 'lncludes.,,.Water Heater ................... $15,,,00 ...........
<br />........ Bath Unit(full) ........ 10.00
<br /> Bath Unit (half) 5.00
<br /> Lau'~'~r~'U nit .......
<br /> 5.00 ,,~<~
<br /> Miscellsneoss Fixtures §00
<br />Sewer Service Line
<br />Private :~h'all be charged pe~ 100' or fract~'~)~ thereof 10,00
<br />Commercia~
<br />1 tO 50 Fix'~res .........
<br /> 5,00 aa,
<br /> '¥ Over 50 Fixtures ...... 3-00 aa,
<br />Alterations & Additions
<br />..~,,,,,,,,,,, Charged at Commercial Rates
<br />Lawn Spri~,k!i,ng Syetem
<br />TO and including ~ach protective device 5,00
<br />Please return complete application SURCHARGE ~. ~O
<br />with the indicated fee.
<br />TOTAL ~* ,~O
<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 within 120 days. I further expressly war-
<br />rant that I comply with the provisions of ORS 701,005 to 701.125 because:
<br />
<br /> t,/~l 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)
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