Laserfiche WebLink
FOR CITY VALIDATION[ <br />Received By: _ [ <br /> <br /> COUNTY <br /> MARION <br />BUILDUNG INSPEC'I'ION DMSiON <br />31 $0 L~c~st~' Dr. NE - Suite C <br /> Salem, Oregon 97305-139E <br /> <br />Offiee: i~one ~8-~147 $:0~am, 4:3~n <br /> FAX <br /> <br />pERMIT NO: <br />Date: <br /> <br />Issued by: <br /> <br /> PLUMBING PERMIT APPUCATION <br />P/ease complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> ~OSS ~~ONS <br /> <br />PERMH'S ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITIIIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br />~y o,,~er (,e,/~,~/,,.oa) (~..~, <br /> <br /> City. sta~, Zip ~r~ <br /> <br /> Ovmer's Sigoa~te <br /> <br /> Agent's Signature <br /> <br />3. PLAN REVIEW <br />· l Marion County does not require a l~l~n <br />~ We will provide plan review service if you complete <br />[ Section 5B and submit two (2) sets of plans and <br />[ ~ificati°m with this application. <br /> <br />4. FEE SCHEDULE (Complete and eater totalin 5-Al below) <br /> <br />RESIDENTIAl., {'1 COMMERCIAL ]~ USE: <br /> <br />BASE FEE Assessed on all applkafious S20.00 <br /> (Exeq~ti~a: Water/Sewer Line Al~lieatiom w~o <br /> <br />~TURES OTY OTY <br />AREA DRAIN INTERCEPTOR <br />BACKFLOW PREV DEVICE LAUNDRY TUB <br />BATHTUB RECEPTOR <br />BIDET SHOrn <br />CATCH BASIN S1NK '( <br />CLOTHES WASHER TROUGH DRAIN -- <br />DENTAL Ub~T TUB~aOWEg / <br />CUSPIDOR UReO~ <br />DRINK/NO FOUNTAIN WATER CLOSET ~ <br />FLOOR DRAIN WATER HEATER <br />OTHER WET BAR <br /> <br />5. FEES <br /> <br />S, <br />S <br />$ <br /> <br />~ 15-45 7/97 <br /> <br /> <br />