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PLUMBING PERMIT APPLICATION <br /> <br />Owner: Phone: M~lng Address: <br /> , Cross Street: . <br />P~ing Installer; / / <br />Home Builder~ Registration No.: <br /> <br />Resldentiah ~ New:' ~ Additbm ~' Occupancy U~e of Building: ~ " <br /> <br /> Base Price NO, FEE AMOUNT <br /> $;~0,00 <br /> Resldential <br /> New construction each fixture .,. $ 9.0'~ <br /> Alterations (each fixture) , .,, g,00 <br /> Re-located Residence (each fixture) ..... 4,50 , ,, <br /> Commercial <br /> NewConstruc~ion. (each fixture) ., "" ~. 9,00 ' <br /> Al~rations (each fixture .. 9.00 . <br /> Water Lines " <br /> For the first lOO feet or fraction thereof , ' 20,00 <br /> For additional 100 feet ' 15,00 <br /> Sewer Service L nas <br /> First 100 feet or fraction thereof · <br /> Additional,. 100 feet,, · ..ts,0g I <br /> Mobile Home sewer/water connection · <br /> (maximum $ fee ength) 25.00 '. <br /> Other (as per OSPSC and Building Official "' <br /> On-Site Technics Rev ew (app y at Medon County only) ' I <br /> ,Re'lnspecti°n Fee , 25.00 <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 $ <br /> <br /> ! <br /> <br />] Sm a registered builder OR (~) the authorized representative of SIGNATU RE Of APPCI~N~ <br />a registered builder <br />Tho work will be ~eaormed by a registered builder, ,e ~ <br />~her <br />l agree to ~nstall ~ralng to the submitted pl~n~ ~n~ soeolficatlons, t ~e laws of the sta~ of Om~on and the o~inan~s of M~rion Coup, <br /> <br />MC 15-45 <br />Rev. 12187 <br /> <br /> <br />