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FOR CITY USE ONLY <br />zaui~ ~: Ci~.. <br /> <br /> ,w.~,.,UON COUNTY ~LD~G u~,~crloN <br /> 3150 Lancas~' Dr. NE - Su/te C <br /> <br />a:O0 am - ¢'20 gm 24 hr. [,, ~ _"~n L/nc 373-4427 FAX 5~-7948 <br /> <br /> PLUMBING PERMIT APPLICATION <br /> Please compile ~ $~don~, I through $ <br /> <br />L LOCATION OF INSTALLA'I'[ON <br /> <br />$i~:add~= 8750 AUMSVILLE HWY. <br /> <br /> AUMSVILLE ~ 97325 <br /> ~ DON GARRISON <br /> 371-3446 <br />CmSm~Di,~mz SOUTHEAST OFF SUEBLER BLVD <br /> <br /> , TOP OUT ADA <br /> <br />~ CO~rRACTOR 17q%'OR,'V~TION <br /> <br /> c~_=~. Judson ' s Inc. <br /> ~vm~m$~ P.O. Box12669 <br /> <br /> Ci~. Salem $~ OR ~: 9730~ <br /> ~c (503) <br /> F= (503) 399-8760 <br /> <br /> m~L~ 5042 P <br /> c~ ~ 2~22PB <br /> ~N= 34604 <br /> <br /> I am ~ PROPER~ O~ER ~ 1 ~ ~ or ~ ~e ~ ~ ~d <br /> <br /> reg~r ~ a coercion <br /> before or upon complego~ ~l ~e ~co~ I ~ ~e o~ <br /> ~bcon~actorx ~g~tered w~ Me Co~cdon Co~c~ B~ Iff <br /> change ~ m~ ~d <br /> Co~caon Co~actor~ <br /> ~e name of ~e con.actor: <br /> <br />Lava Va~m Br~- <br /> <br /> ? <br /> 2, LAVS'. <br />7 x smoo = <br /> x $7_~0 - S <br /> S 7JO - $ <br /> $I0.00 = $ <br /> <br />I;~sid~mial:FL~100t~.m-i--~flammmf x $35.00 -$ <br /> For~mddul 1OO~,up~$0Of~ x S16.00 -$ <br />Coum~-/al-.Fu~ I00 &, ~r ~-~m d~zof x ~]i00 - $ <br /> Fur~addulI00fu~ x ~'0.00 -$ <br /> <br />R~dm~l: Fk'~ I00 t~, x f'a~i~8m~' X ~35.00 <br /> F~ ~-~l,~! I00 ~, up ~ 500 ~ x $16.00 <br /> <br /> F~r ea,,t~t 100 f=~ x ~.0.00 <br /> <br />__ x $I0.0~ =$ , <br /> <br /> #ofLa~s ' ~ ~[~. <br /> <br /> xS .09 -S <br /> $__ <br /> <br />5. FEES <br /> <br />$ ~5.OO <br /> <br />$ ] 05_O0 <br />S 6.50 <br /> <br />~S <br />S' <br />S <br />5 <br /> <br /> S <br />TOTALAMOUNTDUE $1'~F; KC; %/ <br /> <br /> <br />