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COMM~Y D~VELOPMENT CE~R PERMff ~0: <br />FOR C~ VEDATION} 28S ~h St _~.~m 132 <br />R~cived by:~ ] ual~, o~ v/~u i D~ <br /> <br />PLUMBING PERMIT APPLICATION , <br />~e complete m~ ~r~ons, ~ mrougn <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />MARION COt <br /> <br />PERM]TS ARE NON-TRANSFERABLE AHD EXPIRE IF WORK IS NOT <br />STARTED wrrH]N 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR i80 DAYS. <br /> <br />2A. COHTRACTOR II'qSTALLATION ONLY <br /> <br /> ilingA , O0 60' fi; , <br /> <br />2B. FOR OWNER IH'gTALLAT1ONS <br />pmp~ny owner (plee~eprinO <br /> <br />lvlniling Addre~ [ Phone <br />City/Smte/Zip <br /> <br />A~nt's Signature: <br /> <br />NTYusE OF STRUCTUtU{: <br />~%~l~/v rn aLTeRatiON ~ .~,DrrlONJl[ RaLO¢^TION Cl <br /> No. X F~o a= ~um <br /> BASE FEE $20.00 <br /> <br />RBSIDENTIAL (each fntmre) <br /> Aurora Dwelling Plumbil~ Fee sq. ft, x $,065 = <br /> <br />Single Family or multi=family per <br />dwelling unit <br />N~w comtruction $10.00 <br />All~rationa ~ $I0.00 <br />Reconnect $ 5.00 <br />Relocated Structure $ 5.00 <br />Modular Stmeh~e $ 5.00 <br /> <br />maximum of 500 fi.) $15.00 <br />maximum of SO0 fl.) $1S.O0 <br /> <br />Wats Lines <br />First 100 fl. or fraction thereof $25.00 -- <br />For ea. addnl' 100 fl. (up ~o <br />maximum of 500 ft.) $15.00 <br /> <br />Sanil,~y & Storm Lines <br />F/rat 100 fi. or fraction thereof $30.00 <br />For Bddni' 100 ii. (up to <br />maximum 0£500 ft.) $15.00 -- <br /> <br />PROTECTIVE BACK,LOW DEVICE <br />l.~wn vacuum breaikor (sprinkler ayatem) $ 4.30 <br />A{{ others $10.00 -- <br /> <br />OTHER (~s requir~tbyOSP~C <br /> and Building Ol~eiM) <br /> <br />DWELLING PERMIT LABEL # of Labels <br /> <br />3. PLANRBVIEW SECTION <br /> <br />Marion County 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 />specifications with this application. <br /> <br />MC 15-45 <br />Re~. 12/94 <br /> <br />5. FEES Al. Enter wtel of fees from Sec. #4 <br /> A2. Add 5% sttrcharge (.05 x Al) <br /> <br />Subtotal <br /> <br />B. Enter 25% of line Al for Plan Review <br /> (Al + .25), if required <br />C. Investigation Fee (if required) <br />D. Reimpection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br />Receipt No. <br /> <br />s .O0 <br /> <br />tq .OO <br /> <br /> <br />