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Received By: I <br />Date: ] <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DMSION <br /> 3150 Lancostcr Dr. NE - Suite C <br /> Salem~ O~gon 97305-1398 <br /> <br /> 24 HR Inspeetlon Line 373-4427 <br />Office:. phone 588-St47 8:00am - 4:~0pm <br />FAX 588-7948 <br /> <br />PLUMBING PERMIT APPLICATION I <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />OWNER'S <br />PHONE # <br /> <br />PROJECT DESCRIi~TION <br /> <br />PERMITS ARE NON-TRAHSFERABLE AND EXPIRE IF WORK IS NOT I <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> I <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and ~ tomj~ S-Al <br />RESIDENTIAL ~ COMMERCIAL ~Y USE: <br /> <br /> ~mw C! AL~mA'nOS ~ ,~vDmo~ 0'1 RELOC^T~O~ <br /> <br />BASE FEE Assessed on all N)plications $20,00 <br /> (Exception: Water/Sr~,~ Lin~ Applk~ioos w/no fixtures) <br /> <br />BACKFLOW PREV DEVICE LALrNDRY TUB <br />BATHTUB RECEPTOR <br />BIDET SHOWER <br />CATCH BASI~ SINK <br />CLOTH~S WASHER TROUOH DRAIN <br /> <br />CUSPIDOR UPd~AL <br />DRINKING FOUNTAIN WATER CLOSET <br />FLOOR DRAIN WATER F~:ATER <br /> <br /> To~l # Fixlums ~ x $~0.00 <br /> <br />PLUMBING BOARD NO. <br /> <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 />IMariun County does not require a plGn review. <br /> We will provide plan review service if you complete <br /> Section SB and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />R~idenOal: First 100 fi. Or fraction the~of x $30.00 = S <br /> For ea addn1100 ~ Up to $00 feet __ x Sl5.00 <br />Commercial: First 100 fl. Or fm:fion fine.of x $30,00 =S <br /> For ea nddn1100 feet x S15.00 =S <br /> <br /> Residential: Fh~t 100 [ Or fr~ction thereof x $30.00 = S <br /> ForeaMdnl 100fl. Up to S00 feet __ x$15.00 <br /> Contme~ial: F~ I00 ~ Or fi'n~on Ihe~of x $30.00 = S <br /> For ee addnl I00 feet ~x $15.00 <br /> <br />~.l~2~G~.~ # of ~ N/C <br />(Po~ N~w Slr~$1~ Ftmily l~h,~llin~ Only) <br /> <br />$. FEES Al. Entc( ~obd of fees from Sec. ~4 <br /> A2. Add ~A surch~ge (.05 x Al) <br /> <br />Receipt <br /> <br />TOTAL AMOUNT DUE <br /> <br />S <br />$ <br />S <br /> <br />S <br />S <br />$ <br />S <br /> <br />MC 15.45 7/97 <br /> <br /> <br />