Laserfiche WebLink
COMMUNITY DEVELOPMENT CENTER <br />J FOR Crt""'- ID'-'~--' ~5 Church St NE. Room 132 <br />- . ~_~[L~'~..1~1. J Salem, OR 9/301 ~J <br /> Date: ~-~,-~-~ (J [ <br /> O~ce: Phone ~S147 8:00nm - 4:30pm <br /> <br /> PERMff <br /> APPLICATION <br /> Pl~e complete ~1 ~tions, 1 ~rough 5 ' <br /> L LOCA~ON OF ~~ON USE O~ ~UC~: <br /> <br />~S ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED W1THIH 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />C°~Lm~t°r" B°imtR°~'N°'~J~7 '~' I .IobNo. <br />,ourneymnn's Plumbers No. 1y~'~ <br /> <br />2B. FOR OWNBR INSTALLATIONE <br /> <br />Property ~ (~k~prmt) <br />Mailing Address { Phone <br />City/State~ip <br />Owner's Si~u~: <br /> <br />Agent's Signature: <br /> <br /> HEW <br /> <br /> No. X ]Fe~ ~ 8urn <br />BASE FBE <br /> <br />RBSIDENTIAL (~oh fixture) ~ ~0~. <br /> <br /> For ea. add~l' 100 ft. (up {o ['X <br /> nu~xlm, of 500 ft.)~, <br /> First 100 fi. or fraction flxereof ~= <br /> For addnl' 100 fi. (up to ~ I~ <br /> nmximum of 500 ft.) ~,~ <br />COMMERCIAL (~ach fixm~*o)\' ~ <br /> New ~onstruction <br /> Alterations <br /> Reconnect <br /> <br />Water Lines <br /> Ni~t 100 fi. or fraction thereof <br /> For ~ addnl' 100 fl. <br /> <br />$15.00 <br /> <br />$~o <br /> <br />Sanitary & S~m LinoS <br /> Fimt lO0 ft. or fraction 0aer~of <br /> For addnl' 100 ft. <br /> <br />PROTECTIVE BACKPLOW DIRVICII <br /> Lawn vacuum breaker (spriukler system) <br /> All others <br /> <br />OTHER <br /> and Buddi,g O~ci~O <br /> <br />DWELLING PERMIT LABBL //of Lab~k <br /> <br />$10.00 <br />$10.00 <br />$10.00 <br /> <br />$25.00 <br /> <br />$15.00 <br /> <br />$30.00 <br /> <br />$15.00 <br /> <br />$4.~ <br />$10.00 <br /> <br />3. PLAN REVIBW SBCTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application, <br /> <br />MC 15-43 <br />Rev. 1/96 <br /> <br /> <br />