The recent preparation of the Operation and Maintenance (O&M) Manual for Palestinian municipalities is an important step to guide them towards preparing and implementing their O&M priority-based plans, considering scare resources. During the course of preparation of the Manual, the proposed procedures were applied at ten pilot municipalities. This study aims to explore the outcome of the implementation of the 2014/2015 O&M buildings maintenance priorities at these municipalities through the development of maintenance composite priority index (PI). The new proposed priority index is a scientific tool that will identify the priority of maintenance buildings through using a systematic procedure instead of first worst one. The maintenance priority index for buildings is calculated considering different indicators among them building status (condition), classification and importance of the building, number of beneficiaries (users), safety aspects (severity level in the building), and people complaints. The results indicated that the ten municipalities have the same rates for all indicators.