Application Fee / Non-Refundable             Residential Remodeling min 40      Residential Fee 125      Commericaial & Industrial by schedule min 90          Base Permit 25      Fixtures 4      Stacks (Soil, waste, vents & conductors) 3      Sewers (Sanitary, storm or combined) 5        Connection building drain to building sewer 5 Drains 5      Manholes 5      Sewages sumps — Sewage Ejectors 5      Water Distributing Pipe (System) 6      Water Connected App. — Equipment — Devices 3      Floor Drains — Special Drains — Traps 2      Lab Fixtures & Devices — Backflow Preventors 4       Additional Inspections 30        Reinspection 30      Final Inspection 30      Hourly Inspection Rate 30           Total

THIS APPLICATIONS IS FOR: _________________________________ (Print Name of Owner or Agent) _________________________________ (Street Address and Job Location) Village of Spring Lake, Michigan 49546, Ottawa (Village, State, Zip Code & County) WHO IS DOING THE WORK: _________________________________ (Name of Plumbing Firm) _________________________________ (Signature - Plumber/Homeowner) _________________________________ (Address) _________________________________ (City, State, Zip Code) _________________________________ (State License No.) _________________________________ (Telephone No.) HOMEOWNERS AFFIDAVIT I hereby certify the plumbing work described on this permit shall be installed by myself in my own single family dwelling, which I am living, or about to occupy. All work shall be installed in accordance with the State Plumbing Code and shall not be enclosed, covered up, or put into operation until it has been inspected and approved by the Plumbing Inspector. I will cooperate with the Plumbing Inspector and assume the responsibility to arrange for necessary inspections. Signed: _________________________________ TOTAL PERMIT FEE IS DOUBLED IF WORK IS STARTED BEFORE PERMIT IS APPLIED FOR.