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..~ /3 MAI[lION COU~NTY BUILDING INSPECTION <br />. _~ Rece'l~'~d By:: ~.~¢=~.,~.~,~..f..~.~./ .,,. Senator aldg. NO. 22S <br />~_ ~ ~ ~ ~ ~ ~20HIghSt~tNE <br /> <br /> ~ ~ ~ - - , C~Phone4:30P,~,-B:00A,M,, <br /> <br />Job Address <br /> <br />Plumff&qg Installer ~, O, , <br /> <br />Home Builders' Re~istratio~"No <br />Residential;; ~ ' New:: ~'- <br />Commemiak ~ Alteration ~ <br /> <br />Phone: <br /> <br />Site No <br /> <br />Phone:: <br /> <br />Addition' <br />Relocation:; <br /> <br />Occupancy Use of Bud ng <br /> <br />Residential <br /> <br />New construction (each fixture) <br /> <br />Alterations (each fixture) <br /> <br />Re-located Residence (each fixture) <br />Commercial <br /> New Construction (each fixture) <br />Alterations (each fixture) <br /> <br />Water Lines <br /> For the first 100 feet or fraction thereof <br /> <br />AMOUNT <br /> $20,00 <br /> <br /> For additional 100 feet <br />Sewer Service Lines <br /> First 100 feet or fraction thereof <br /> <br /> Additional 100 feet <br />Mobile Home eewer/water connection <br /> (maximum 5 feet length) <br />Other (as per OSPSC and Suildiog Official) <br />On-Site Technical Review (apply at Marion County only) <br />Re-inspection Fee <br /> <br />NO FEE <br /> <br /> $ 900 <br /> 9,00 <br /> 45O <br /> <br /> 9 00 <br /> 900 <br /> <br /> / 20,00 <br /> 1500 <br /> <br /> / so,co <br /> 1500 <br /> <br /> 2500 <br /> 25.00 <br /> <br /> FEE <br />STATE SURCHARGE <br />PLAN REVIEW FEE <br />INVESTIGATION FEE <br />FLEET SURCHARGE <br />CiTY FEE <br /> TOTAL <br /> <br />Please return COMPLETE APPLICATION <br />with the indicated fee <br /> <br />( ) lamperformingwokonaptoperty ownoroccupy <br />( ) lamereglsteredbuifderOR( )theauthorizedmpresentettvoof <br /> a reglslered builde[ <br />(~X~) The work will be performed by a registered builder <br />( ,~ Other <br /> <br />$ <br /> <br />MC 15-45 <br />Rev 12/87 <br /> <br /> <br />