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08/11/9~ 10:05 <br /> <br />R~,v olwd by:. <br /> <br /> 2~5 Church <br /> <br /> 0~: 58~5147 <br />~Lt'MBIN6 PERMIT APPLICAnON ] <br />Plesse complete ~1 ~gofls, I through 5 <br /> <br />Propaay Owner (please£rlnt) <br /> <br />Mailin8 Addn:~ 'l Pbon: <br /> <br />3. PLAN RkgVl~W SECTION <br /> <br />Marion C0tmty does not require a plan review. <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />=peeifications with this application. <br /> <br />15-45 <br /> <br /> USE OF S~UCT~; <br /> NEW ~ ~TE~TION~ ~D~ION D ~' OCATION ~ <br /> <br /> N~ X F~ = Sum <br /> <br /> A~ra Dwelling Pl~bi~ Fee ~ rq. a. x $.065 ,' ~.~ <br /> <br />~elllng unit <br /> <br /> Mtcrakiom ~ $10.00 ...... <br /> ~o~t $ 5.00 ~ <br /> ~elocaIed $I~om~ $ 5,00 <br /> Modalae 8~ctu~ $ <br /> <br />maximum of 500 ft.) <br />maxim;~m or'500 <br /> <br />First 1oo rt. or <br />F~r addnP 100 <br /> <br />530.00 <br /> <br />$15,00 <br /> <br />PROTECTIVE EACKFLOW DEVICE <br /> <br />$I0.0o <br />$10 <br /> <br />$30.00 <br />$13.00 <br /> <br />$ 4,50 <br />$lO.OO <br /> <br />OTHER (os requ~dbyOSPg2 and Buildi.$ <br /> <br />D'W'ELLiNO P£RMrr LABEL <br /> A2~ Add 5% s~cha~ (.~ x <br /> <br />No. <br /> <br />TOTAL AMOUNT DUI~ <br /> <br />$--J_~.~5 <br />s -3 ¢, ,,7 - <br /> <br /> <br />