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Phone 5eS~S147 <br /> <br />[~J[LD[~¢c [N~[>E~I~,[.IMBING PERMIT APPLICATION <br /> <br />Job .~d d re ~s-. ....... Z <br /> <br />P~, brag InsCcller:: · <br />~o~n~e"~'~s Registration NO, <br /> <br />Residential <br />Commercial' <br /> <br />Phone <br /> <br />Site No <br /> <br />Phone <br /> <br />JNew ~;~" Addition <br /> Alteration:: [] Relocation:: <br /> <br />Occupancy ] Us~ofBuilding; ' <br /> <br /> AMOUNT <br />ease Price $~0,00 <br />Residential <br /> <br />New construction (each fixture) <br /> <br />Alterations (each fixture) <br /> <br />Re-located Residence (each fixture) <br /> <br />Commercial <br /> <br />New Construction (each fixture) <br /> <br />Alterations (each fixture) <br /> <br />Water Lines <br /> <br />~or the first 100 feet or fraction thereof <br /> <br /> For additional 100 feet <br />Sewer Service Lines <br /> First 100 feet or fraction thereof <br /> <br />Additional 100 feet <br /> <br />Mobile Home sewer/water connection <br /> (maximum 5 feet length) <br /> <br />"~ther fas per OSPSC and Budding Official) <br /> <br />On-Site Technical Review (apply st Msrion County only) <br />Re-inspection Fee <br /> <br />Please return COMPLETE APPLICATION <br />with the indicated fee, <br /> <br /> NO FEE <br /> <br />'~ $ 900 <br /> 900 <br /> 4.50 <br /> <br /> 9 O0 <br /> 9O0 <br /> <br /> 20 O0 <br /> 1500 <br /> <br /> 3000 <br /> 15 O0 <br /> <br /> 25 cO <br /> 25 O0 <br /> <br /> FEE <br />STATE SURCHARGI~ <br />PLAN REVIEW FEE <br />INVESTIGATION FEE <br />FLEET SURCHARGE <br />CITY FEE <br /> TOTAL <br /> <br /> .,yo <br />$ <br /> <br />$ <br /> <br />I am performing work on ~ ptoper~ I own or occupy <br />I am ~ registered builder OR ( ) the authorized representative Of SIGNATURE OF APPLICANT <br /> <br />'""'MC 15-45 <br /> ROy, 12/87 <br /> <br /> <br />