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Salem, Oregon g~01 <br /> <br /> Phone ~88-5147 <br />~.~ ~ e,.~ ~/'''~ COOe-A-Phono4:aORM,,-S:00A.M. <br /> <br />PLUMBING PERMIT APPLICATION <br /> <br />Jab Ad_dressy: Site NO ~ <br /> <br />Plum bi,0,g In~taller:: <br /> <br />Mailing Address <br /> <br />Home Builder:s Registration No ;: <br /> <br />Residential;: ~ <br />Commercial;; [] <br /> <br />iNew:; <br /> Alteration;; <br /> <br />Addition:: [] Occupancy ,, Ure~,,uildin~. <br />Relocation:: [] Change:; [] <br /> <br />Sase Price <br />Residential <br /> New construction (each fixture) <br /> <br /> Alterations (each fixture) <br />Re-located Residence (each fixture) <br />Commercial <br /> <br />New Construction (each fixture) <br /> <br />Alterations (each fixture) <br /> <br />Water Linea <br /> For the first 100 feet or fraction thereof <br /> <br /> For additional 100 feet <br />Sewer Servl0e Lines <br /> <br />First 100 feet or fraction thereof <br /> <br />Additional 100 feet <br /> <br />Mobile Home sewet~vater connection <br /> <br /> (maximum 5 teat ~ength) <br />Other (as per OSPSC and Buildlnd Official) <br />On-Site Technical Review (apply at Marion County only) <br /> <br />Reqespection Fee <br /> <br />Please return COMPLETE APPLICATION <br />with the indicated fee,, <br /> <br />I am a registered builder OR ) the authorized representative of <br />a registered builder, <br /> <br />Other <br /> <br />NO FEE <br /> <br /> $ 900 <br /> 9,00 <br /> 450 <br /> <br /> g O0 <br /> 9.00 <br /> <br />/ 20.00 <br /> 1500 <br /> <br /> / 30,00 <br /> 1500 <br /> <br /> 2500 <br /> <br /> i 2500 <br /> FEE <br />STATE SURCHARGE <br /> PLAN REVIEW FEE <br />JNVF..STIGA¥iON F~ <br />FLEET SURCHARGE <br /> CITY FEE <br /> TOTAL <br /> <br />AMOUNT <br /> $20,00 <br /> <br />( ) l agree to install a¢cordin9 tothe submitted plans and specificePon$: the laws of the state of Oregon afld t~¢ordinances of Madon County <br /> <br />MC 15-45 <br />~ev 12f87 <br /> <br /> <br />