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IPLUMBING PERMIT APPLI~ INSPECTION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARR NON-TRANSFF-.RABUg AND EX~IRE tF WORK IS NOT <br />STARTED ~ 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSI~qDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Plumbing Boa~: <br /> <br />Job No. <br /> <br />2B. FOR OWNI~ INSTALLATIONS <br /> <br />4. FEE SCHEDULE (Complete and entc~ total in A1 below) <br /> <br /> R.ESIDBNTIAL O COMMERCIAL O <br /> USE OF STRUCTURE: <br /> NEW 0 ALTERATION El ADDITION CI RELOCATION <br /> <br /> No. X Fee = Sum <br />BASE FEE $2o. oo <br /> <br />maximum of S00 fl,) $15.00 -- <br />m~imum of 500 fl,) $15.00 -- <br /> <br />$~,00 -- <br />$15.00 -- <br /> <br />Sanitary & Santo Lines <br /> Firat 100 fl. or fraction thereof <br /> For addnl' 100 ft. <br /> <br />$30.00 -- <br />$15.00 <br /> <br />PROTECTIVE BACKFLOW D£VICE <br /> Lawn vacuum breaker (sprinkler system) <br /> All olhcrs <br /> <br />$4.50 -- <br />$10.00 -- <br /> <br />OTHER (as requir~d by OSPSC <br /> and Buildin~ OEicial) <br /> <br />DWELLING PERMIT LABEL # of Label~ <br /> <br />N/C <br /> <br />3. PLAN RI~VIEW SECTION <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. FEES <br /> <br /> (Al + .25), if required <br /> <br /> TOTAL AMOUNT DUB <br /> <br /> <br />