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Ow ' ' Phone~ M ~,i~ing <br />Job Address',' · Site No,: Gross Street: <br />Piu~bing Installer: x Phone: ' ~./~,.~z~/ Address; <br /> <br />Residential: ~ New: ~' Addition: ~ Occupan~ U~ of Building; <br />Oo~mercial: U Albert. on: ~ Belocation: ~ Change: ~ <br /> <br /> NO. FEE AMOUNT . <br /> Base Price $20.00 <br /> Residential <br /> New construction (each1 fixture) $ 9.00 <br /> Alterations (each !!xture) 9.00 <br /> Re-located Residence (each fixture) .,, 4.50 <br /> Commemial <br /> <br /> ' New Construction (each fixture.) 9.00 .... ,, <br /> Alterations (each fixture) 9.00 <br /> Water Lines <br /> For the fipst 100 feet or fraction thereof / 20.00 <;~.-.-.-.-.-.-.-3~, <br /> For additional 100 feet 15.00 <br /> Sewer Service Lines "' <br /> <br /> . First 100 feet or fraction thereof , ,/ S0.00 ~f.~, <br /> Additional 100 feet 15,00 <br /> .Mobile Home sewer/Water connection <br /> (maximum 5 feet length 25,00 <br /> Other (as per OSPSG and Building Official <br /> On-Site Technlcal 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, c TY FEE $ c~,G"'~) <br /> <br />(,,¢~) la~amgisteredbuilderOR( )theauthorizedreprese~tativeof SIGNATUREOFAPPLICANT. <br />(~,,¢~ ThegWork will be performed by a registered builder. , <br />( . ~..Other <br /> <br />MC 15-45 <br />Rev. 12/87 <br /> <br /> <br />