|
R~ce ved By
<br />Date:
<br />
<br />MARION COUNTY BUILDII
<br />
<br />~$PECTION
<br />
<br />JobAdd~ss: ~ _ / Sl~ NO ...... C~sSt~et ~, . ~ ,.,
<br />
<br />Plum61ng nsta er Phone, ' .... ~d~ ~"~ ~ . ..... .... ' '
<br /> .
<br /> .................,'"' ...... :, .....
<br />Home Builder~ Registration NO ' ', ~ '
<br />Resideetial: ~ New:
<br />Commercial: ~ Aterat on
<br />
<br /> Residential ' ' '"' ? ' ...... ., N,~ ..,~ il, ,~', ,~ F,E~ ,~ . .AMOUNT....,/
<br /> Alteratl n~ (each fixture) , ...... , ~. .:,, ,,,.
<br /> Re-lac ~h t
<br /> ated Residence (ea fix urn). ' ,
<br />
<br /> Almrations (each fixture ......... ' ' , ...... '
<br /> . , ., · ~ , ~'; ,~9;00~ .,,
<br /> Water Lines "
<br /> Fortheflrstl00feetorfract0~th'e~f ' '' ' '' ' "' ' ,'~' ,,
<br /> ',.~ ,. .... :,~,, .20,00, "~' ¢/ '
<br /> ...... · ....... r' ",:' "TS.0o ......
<br /> First 100 feet or fraction ~hemof ' ' ' ' , ~ '
<br /> .... ,30.00.
<br /> Additional 100 fee~ '~ .;' ,, ' ' ~ ..... · ·, ,
<br /> (maxlmu 5fd~length) ' : ' ..... ' ' ' ' '
<br /> , , · .... 2s -~,,~ O ,
<br />~her asperO$PSOandBuildingOffsa) · ..... ' -, %, ' ; ' ' .. '., %'~& .
<br />· :.' ',' .*' .... ~ N~TIG~TeNEEE ,$ ,, ,~., ,
<br />Please return COMPLETE 'APPLICATION
<br />w~th the mdmated fee, , .
<br />
<br />) I am performing w0rk on a property i own or o~upy.
<br />) i am a mgietemd builder OR , the authorizeo representative of
<br />
<br />MC 15-45
<br />
<br />
<br />
|