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MARI~O..~N,..?~Y BUILDING INSPECTION <br /> ~ e-.~ t-~X-'~ ~g~[~/H~DEVELOPMENT CENTER <br /> ~tlx~ ~ t~ ~.J ~ Lg ALI 2i~C~drl~h St NE · Room 132 ~-~r,w,,, ,.,..: <br /> FOR CXTV <br /> R~eiv~ by: ll~ ~ /~. ~ Date: <br /> Date: L~ I ~ X ~24 ~ l~ection Line 373~427 <br /> O~ Phone 588-~147 8:00am - 4:30pm ISBO~ by: <br /> ~ ~ GOD~ ~ ~ FAX: 58~7948 <br /> <br />IPLUMBING PERMIT <br /> Ple~e complete ~1 ~ti~ns, I through ~ ~ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED V~ITHIN 1~0 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> ', <br /> <br />~. FOR O~ <br /> <br />Property Owner (ples~pHnt) <br />Mailing Add~s ~ Phon~ <br /> <br />Agant'a Slguatur~: <br /> <br />4. FEE SCHEDULE (Complete and entex total in Al below) <br /> RESIDra.NTIAL ~/ COMMERCIAL ~ <br /> USE OF STRUCTURE: <br /> NEW ~3 ALq~RATION O ADDITION ~ RELOCATION <br /> <br />BASE FEE <br /> <br />RESIDENTIAL (~ch fixture) <br /> <br />PROTECTIVE BACKFLOW DEVICE <br /> Lawn vacumn br~nker (sprinkler system) <br /> All others <br /> <br />OTHER (ss requiced by OSP~C <br /> and Building Ol~ciaD <br /> <br />DWELLING PERMIT LABEL <br /> <br />No. X F~ /~$~.~ <br /> <br />__sq. fi, x $,070 = <br /> <br />MO,gO <br />$10.00 -- <br />$ 5,00 -- <br />$ 5DO -- <br />$ 5.00 <br /> <br />$20.00 <br /> <br />$15.00 <br /> <br />$30.00 <br /> <br />$15.00 <br /> <br />$10.00 -- <br />$10,00 <br />$10.00 -- <br /> <br />$25.00 -- <br /> <br />$30.00 -- <br /> <br />$15.00 <br /> <br />$ 4.50 -- <br />$10.00 <br /> <br />3. PLANRlgVIBW SBCT1ON <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />MC 15-45 <br />Rev. 1/96 <br /> <br />5. FF~S <br /> A 1, Enter total of fees from Sec:, #4 <br /> A2, Add 5% surcharge (.05 x Al) <br /> <br />B. Enter 25% of line Al for Plan Review <br />(Al 4- .25), if required $__ <br />C. Investigation Fee (if required) <br />D. Reinspection lee ($25.00) <br /> <br /> TOTAL AMOUIWr DUE $. <br />Receipt No. <br /> <br />Mbtotal $__ <br /> <br /> <br />