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By" . 8enatc,,r [,id{. No~ 225 <br /> 220 Hi~mh ~treet NE <br />/y- %?0 <br /> Code-A-Phone 4;$0 EM. - 8:00 A.M. <br /> <br />PLUMBING PERMIT APPLICATION <br /> <br />IOwner <br /> <br /> Job Address' <br /> <br /> '{u.~bin{] Installer <br /> <br />Phone:: <br /> 'Y4/q --/5;z 7 <br />Site No :; <br /> <br />Phone', <br /> <br />Home 13uilder's Registration NO., <br /> <br />Residentiak ~ Ne~':: ¢~"'"~ ' Addition;; [] <br />Commercial:: [] Alteration:: [] Relocatlorl:: [] <br /> <br />Occupancy Uc,e of Building, <br /> <br /> NO, IFEE AMOUNT <br />Sase Pricer .... $20,,oo <br />Residential <br />New ~onstruction (each !ixture) .... $ 9 i00 <br />AIteratlonc, (each fixture) 9,00 <br />Re4oc,ated Bssidance (each fixture) 4,50 <br />Nev~, Construction (e~ch fixture) , 900 <br />Alterations (each fixture) 9.00 <br />Water Lines <br />~or the first 100 fe~t or fraction therec,f 2000 <br />For additlotla1100 feet 15.00 <br />Sewer Service Lines <br />First 100 feet or fraction thereof '"3000 <br />Additional 100 feet 15.00 <br />Mobile Home sewer/water COnnection <br />Other (as per OSPSC and Building Official) <br />"~-Site Te,chnieal Review (~pply at M'arion County chili <br />~_R~lnspection Fee ,, ~.00 <br /> <br /> STATE SURCHARGE /ii ~ ~ <br /> PLAN REVIEW FEE $ <br /> INVESTIGATION FEE $ <br />Please return COMPLETE APPLICATION FLEET SURCHARGE $ ~,,~4,~ ,,.~. <br />with the indicated fee,, CiTY FEE $ ~./~ ~ ~ <br /> <br />) I am performing work on a property I own or ocupy <br />) {arnaregisten~dbui[derOR( )theauthorizedmpresentativeof SIGNATUREO~APPLICANT[~/.~{/J L.)(-u~' <br /> <br /> <br />