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Owner: Phone: Moiling Address: <br />Job Address: Site No.; Cross 8treat; <br />Plumbing Installert Phone; Addbss: <br />0 ~ ~.......... <br />Nome Suilder's Registration No.; <br /> <br />Residenti'~i': J~ New: J;~ Addition: ~] Occupancy Use of Building: <br />Commercial: [] Alteration: [] Relocation: [] Change: n ~,~/'-1 ~= <br /> <br /> NO, FEE AMOUNT <br />Base Price $20.00 <br />Residential <br />Newconstructlon (each fixture) ...... I ,.~ $ 9.00 <br /> <br />Alterations (each fixture) <br /> <br />Re-located Residence (each fixture) <br /> <br />Commercial <br /> <br />New Gonottuution (each <br /> <br />Alterotions (each fixture) <br /> <br />Water Lines <br /> <br />For the first 100 feet or fraction thereof <br /> <br />For additional 100 feet <br /> <br />Sewer Service Unes <br /> <br />First 100 feet or fraction thereof <br /> <br />Additional 100 feet <br /> <br />Mobile Home sewer/~Nater connection <br /> <br />(maximum 5 feet length) <br /> <br />4,50 <br /> <br />9,00 <br /> <br />9,00 <br /> <br />20.00 <br /> <br />15,00 <br /> <br />30.00 <br /> <br />15.00 <br /> <br />7.o .o c~ <br /> <br /> 25.O0 <br />Other (es per OSPSC and Building Official) <br />On-Site Technical Review (apply at Marion County only) <br />Re-lnspecllon Fee 25,00 <br /> <br /> FEE <br />STATE SURCHARGE <br />PLAN BEVIEW FEB <br />INVESTIGATION FEE <br />FLEET SURCHARGE <br />CITY FEE <br /> TOTAL <br /> <br />Please return COMPLETE APPLICATION <br />with the indicated fee, <br /> <br /> I a111 a registered builder OR ( ) the authorized representative of 51GNATU RE OF APPLICANT~ ~ <br /> a registered builder, <br /> <br /> ether <br /> <br />MC 15-45 ,~ <br />Rev, 12/87 <br /> <br /> <br />