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"'~)~ nar :: ...... Phone:: Mc, iling Address - <br />Job Add.ss;; Silo No,;: Cross Street, <br /> ¢5~.,,,.,,,,,,,~,~ ~m3u///~ CJ~q CJr4~ _ <br /> Plumbing Installer:: ~ Phone:: Add'ess:: <br /> / <br /> Home BuildeCs Registration No / <br /> <br /> R~si~entl~l:: ~ ................ ~ ' ~ Addition;; ~ Occupancy U~ of Building, <br /> Commercial ~,, Alteration:: ~ Relocation;; ~ Change:: ~ <br /> <br /> NO FEE AMOUNT <br />ease Price $2000 <br />Residential <br />..... ~,ew construci'i~l (each fixture) .................. -- $ gO0 <br />Alterations (ea~.h, !ixture) 9 O0 <br /> Re-located Residence (each fixture) * 4~0 <br /> Commercial <br /> <br />............... NOw Constructien'ieach fixture) ........... gOO ........... <br /> <br /> Altara, ticns (each,, fi,xt~re) __ 9,00 <br /> Water Lines <br /> For the first 100 feet or fraction thereof ,/ 20 00 <br /> For additional 100 feet 15 00 <br /> Sewer Service Lines <br /> First 100 feet or f re~,i, .on,,,!,hereof ,/ 30,,00 .____~, 00 <br /> Additional 100 feet 1~00 <br /> Mobile Home sewer/water connection <br /> (maximum 5 feet length) 25.00 <br /> Other (as per O.,~P$C and Building Gifi~lal -- <br /> On-eiteTeehnlcal Review apply at Mari.o,n,(~ountyonly <br /> Re-Inspection F~, 2500 <br /> FEE : $ <br /> STATE SURCHARGE <br /> PLAN REWEWFEE <br /> INVESTIGATION FEB <br />Please return COMPLETE APPLICATION FLEET SURCHARGE $ <br />with the indicated fee. C~TY FEE $ <br />TOTAL $ ,,.~ ~/.~ <br /> <br />I am a registered builder O R ~the authorized repllesentative of SIGNATURE OF <br /> <br />MC 15-45 <br />Rev 12/87 <br /> <br /> <br />