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BUILDING INSPECTION DIVISION PERMIT NO: <br /> <br />' [ FOR CITY VALIDATION 3150 Lancaster Dr. NE- Suite C <br /> <br /> Date: I ~ ~ i ~- -~ -~ 24 HR Inspection Line 373-4427 <br /> Issued by: <br /> Office: .~g"a~l~7-~a m - 4:30om <br /> <br /> PLUMBING PERMIT APPLICATION ~t~'~ m ~.~/~ <br /> ~SlDENT[AE ~ COMMERCIAL ~ ~SE: <br /> BASE r~ Assessed on all ~plications $20.~ <br /> <br />1. LOCATION OF INSTALLATION tc/gRI01 <br />TAX ACCO T NO, Ix-l-Tl I ?1 I-I <br /> JOB ADDRESS O ~0 <br /> <br /> PE~ITS A~ NON-T~NSFE~BLE A~ E~I~ IF WO~ IS NOT <br /> ST~D ~ 180 DAYS OF ISSUANCE OR W <br /> WO~ IS SUSP~ FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />Plumbing Contractor <br /> <br />Mailing <br />Address <br /> <br />PLUMBING BOARD NO. <br /> <br />COI, YIRACTORS BOARD <br />REGISTRATION NO. <br />JOURNEYMANS <br />PLUMBERS NO. <br /> <br />CONTRACTOR'S SIGNATURE <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />3. PLAN REVIEW SECTION <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 /> (Exception: Water/Sewer Line Applications w/no fmtures) <br />~ OTY OTY <br />AREA DRAIN INTERCEPTOR <br />BACKFLOW PREV DEVICE LAUNDRY TUB <br />BATHTUB RECEPTOR <br />BIDET SHOWER <br />CATCH BASIN SINK <br />CLOTHES WASHER TROUGH DRAIN __ <br />DENTAL UNIT TUB/SHOWER <br />CUSPIDOR URINAL <br />DRINKING FOUNTAIN WATER CLOSET -- <br />FLOOR DRAIN WATER HEATER -- <br />OTHER WET BAR. <br /> <br /> Total # Fixtures x $10.00 = $ <br />Lawn vacuum breaker / sprinkler system x $4.50 = $ -- <br /> <br /> Residential: First l0O fl., Or fraction thereof __ x$20.00 <br /> For ea addnl l00 fl Up to 500 feet __ x$15.00 =$__ <br /> Commercial: First 100 ft. Or fracdon thereof ~t x $25.00 = $ _~ <br /> For ea addn1100 feet <br /> <br /> Residential: First 100fl. Or fraction tbereof -- x$30.00 =$__ <br /> For ca addn1100 fi, Up to 500 feet __ x $15.00 <br /> Commercial:First 100 <br /> For ea addn1100 feet x $15,00 <br /> <br /> STORM DRAINS <br /> Residential: First 100ff. Or fraction thereof -- x$30.00 =$__ <br /> For ca addn1100 fi. Up to 500 feet x $15.00 = $__ <br /> Commercial: For 100 <br /> For ea addni 100 feet x $I5.00 = <br /> <br />MINOR INSTALLATION LABELS x $50.00 = $ __ <br /> (Pack of l0 labels ~ $5.00 each, sold only to Plumbing contractors) <br /> g of Labels N/C <br /> (For New Single Family Dwellings Only) <br /> <br />5. FEES <br />Al. Enter total of fees from Sec. 04 <br />A2. Add 5% sumhatge (.05 x Al) <br /> Subtotal <br />B. Enter 25% of llne A 1 for Plan Review <br />(Al + .25), if required <br /> <br /> D. Reinspection Fee ($25.00) <br /> Receipt No. ~02~ TOTAL AMOUNT DLrE <br /> <br />MC 15-45 7/97 <br /> <br /> <br />