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FOR OFFICE USE ONLY MARION COUNTY BUILDII~i~N~:T}t~i)I~ <br /> <br /> /~-/~ <br /> FAX 568-~46 <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. Job Description <br /> <br />~i~FFiCE USE ONLY <br /> <br />" ) <br /> <br />RESIDENTIAL COMMF~C2[AL <br />[ ] NewSFDw/garagc [ ] Accessory [ ] New [ ] Sign <br />[ 1 New SFD w/o garage [ ] Reloeale [ ] Addition [ ] Demo <br />[M'/Addition { ] Demo [ ] Alteration [ ] Other <br />[t~Alteratkm [ ] Other [ ] Changc/OccupancT <br /> <br /> Use of Building: ~.~r~// ~"~t~b ~ ~ <br /> No. Storiei: ] ] llascmcmt: Y [ ] N r [dy/ ]Gross Floor ^tea: ,,~ [ Flelsht: /// I Occupant Loath <br />2. LocatiOn of Installation <br /> <br /> Or - g ff 7- -+ so. <br />Mobile Home Park Space ~ <br />.................. Re gn ...... <br />/~ ~ ~mmityWe~ [ ] City [~ <br /> <br />3. Contractor Information <br /> <br /> ~ Owner Address & Phone No. <br /> <br /> Contractor Business Name & Number Mailing Addres~ & Phone No. <br /> Architect Mailing Address & Phone No. <br /> <br />4~ Septic Information (Check where applicable) <br /> <br /> [ Other ~ <br /> <br />[..~4~-r-~ g ~¢ ,o build according to thc submitted plans and spccifications, thc laws of <br />Signature of ^pplkaot <br /> <br />5. Fee Schedules <br /> <br />A. New Cboe-and-Two Family Dwelling Co~ Valuation: <br /> (iacludcs El, Me. Fl) <br /> <br />(1) Sq, Ft, x .25 <br />(2) 5% State Surcharge (.05 x Al) <br />O) Ba*e ]Fee for Plan Review <br />(4) Zoning Surcharge (If Applicable) <br /> <br /> 185,00 <br />Subtotal: $__ <br /> <br />(Permit fee determined by valuation. <br />~1, Me, P1 am separat~ permits,) <br /> <br />(1) Penni* Fe~ <br />(2) 5% State Surcharge (,05 x B 1) ,,, I, <br />(3) Zoning Sumhargn (.05 x <br />(4) Plans Check (.65 x BI) <br /> <br />Valuation; <br /> <br />$cpilc ~ecs 0~ncludes DEQ Surcharge) <br />(I) Slt~ Evaluation <br />(2) New Sep[k <br />(3) Au~mti~ N~ <br />(4) ~ist~g Sysmm <br />O) Major <br /> M~ R~ir Cank rely) <br /> <br />Subtotal: $___ <br /> <br />(1) Driveway w/curb @ $7.50 <br />(2) Driveway w/o curb @ $17.00 <br />(3) Sile Plan Review (commercial truly) @ $79,00 <br />(4) ~vesfigariem Fee <br />(5) Relnspeciion Fee @ $25.00 <br />(6) Other inspections not list~d above <br /> <br /> ~ $40 = <br />I oral: $~Z~ <br /> <br />Receipt: .... <br /> <br /> <br />