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Received <br /> <br />Job Address Site No:: <br /> <br />Plumbing Installer ¢ <br />Home Builder~Regiatration NO <br />Residential;; ~ New <br />Commercial;: ~ Alteration;: <br /> <br />Phone <br /> <br />Addition:: [] <br />Relocation: [] <br /> <br />Occupancy Usc,.c,f Building :: <br />Ch,,nge;; [] <br /> <br /> NO, FEE AMOUNT <br /> Base Price $20 O0 <br /> Residential <br /> New construCtion (each fixture) $ 9,,00 <br /> Alterations (each fixture) 9 O0 <br /> Re-located Residence (each fix~u.r~! ....... 4, 50 ........... <br /> Commercial <br /> New Construction each fixture 900 <br /> Alterations (each fixture .............. 900 <br /> Water Lines <br /> For the first 100 feet or fraction thereof ........... / 2000 <br /> For additional 100 feet 15,,00 <br /> Sewer Service Lines <br /> Fir2!,.!,00 feet or fraction thereof .......... t ............. ~0,,00 ,,~. "~'4 <br /> Additional 100 feet 1500 <br /> , Mobile Home sewer/~vater connection <br /> (maximum,~,,fcet length) .... 25 00 ....... <br /> Other (as per OSPSC and Building Official) <br /> On-Site Technical Review (apply at Marion County only) <br /> Re-InspeCtion Fee 25,00 <br /> FEE $ <br />STATE SURCHARGE <br />PLAN REVIEW FEE $ <br />INVESTIGATION FEE $ <br />Please return COMPLETE APPLICATION FLEET SURCHARGE $ ~. <br />with the indicated fee. CITY FEE $ ,,~, ,,,~-D. <br /> <br />) ether <br />) I agroe to install according to the submitted plans and specifications+ the laws of the state of Oregon end the ordinance~ of Marion County <br /> <br />MC tS-4a <br />Rev 12/87 <br /> <br /> <br />