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Application Received <br />Date / ol7¢ <br />App~d <br /> <br />Date <br /> <br /> Marion CounW <br /> <br />DEPT. OF BUILDING INSPECTION <br /> <br />COURT HOUSE, SALEM, OREGON <br /> <br />PLUMBING INSTALLATION <br /> <br />Permit Fee /~Z ~:/ <br />.aeeiptNo. <br /> <br />Address ~J"-( ¢~ /?/L/Lb <br /> <br />Owner "~,,f}~ %_~ ¥'T J'~_~ /1~/(° ~ Addr~/?( F <br /> <br />Phone <br /> <br />APPLICATION TO INSTALL <br /> <br />Water Closets <br /> <br />Bath (tub) <br /> <br />Basins <br /> <br />Rain Drains <br /> <br />.~Sinks <br /> <br />Laundry Trays No ........... / <br />Garbage Disposal No. / <br /> <br />Other Fixtures not specified above <br /> <br />Drinking Fountains No,, <br /> <br />Shower Baths No,, <br />Wash Racks No,, <br />Drains, Stable No <br />Drains, Garage No, <br />Drains, Floor No, <br />Dishwasher No. <br /> <br />/ <br /> / <br /> <br />Urinals No .................. <br />Slop Sinks No ............... <br />Sump Pumps No <br />Boiler Blow Off No,, <br /> <br />Refrigerator Wastes No ........... <br />Automatic Washers No J <br /> <br />Water Heaters No J_ ............ <br /> <br /> <br />