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FOR CITY VALIDATION <br />R~clveA by.. <br />Date: ., <br /> <br />iMARION COUNTY <br /> BUILDING <br /> 31! :{ DR NE- SUITE C <br /> SALEM 0 )7305-1398 <br /> <br /> 24 hr. <br /> Office: Pho <br /> <br />PERMIT NO: <br /> <br />D~te; <br /> <br />Issued by: <br /> <br />IPLUMBING PERMIT APPLICA'r[ON <br />P/ease complete all Sections, 1 through 5 <br /> <br /> 1. LOCATIOH OF I~]STALLATION <br /> <br />.[ob D~ripfion: <br /> <br />2A. CONTRACTOR ]~ISTALLh.TIOH ONLY <br /> <br />[ Co~u'ac~or'~ Si~um:~F~J.,, <br /> <br /> FOR OWNBR <br /> <br />ALTERATION O ADDITION O RELOCATION <br /> <br />BASE FEE ~0.00 <br /> <br />DWELLINO PERMIT LABEL # of Labels <br /> <br />JUL-21-199? 11:15 [ 503 58B 794~3 <br /> <br />TOTAL AMOUI'4T DU~ <br /> <br />P.O1 <br /> <br /> <br />