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FOB OFFICE USE ONLY <br /> <br /> ' <br /> <br />MARION COUNTY BUILDt~'~G, IN~PE_CTIO~ ~ ,~QR OFFICE USE ONLY <br /> <br /> Code-A-Phone ~8-7904 ¢ <br /> <br /> DWELL~NG/STRUCTLIRAL <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. Job Description <br /> <br />RESIDENTIAL ~Ac¢ COMMERCIAL <br />f ] NewSFl) w/garage [ essory [ ] Ne,~ [ ] Sign <br />[ ] New SI4D W/o garage [ I Relocate [ ] Addition [ ] Demo <br />[ ] Additwn [ ] Demo [ ] Alteration [ ] Other <br />I / Alteration [ ] Other [ ] Change/O¢¢upanc3~ <br /> <br />2, Location of Installation <br /> <br />Socm,n ~ ~' To*nshlp ~ ~ ~angc ~ ~a =ne ~ ~ Ma~ Water Supply <br /> <br />I~t Width / ~t l)epth~/ Aem$ : I~g ~t ~ Comcr~ PrlvateWell 1 ] Spring [ J <br />~ffj~ Communit~ Well [ ] Cit~ 1~ <br /> <br />3. Contractor Information <br /> <br />Prop/~rty Ownm Mailing Addm*s & Phone No. /]~dq <br /> <br />A. uth Agcnt/I x'asoe <br /> <br />Mailing Add.ss & Phone No <br /> <br />4. Septic Information (Check where applicable) <br /> iimposed No Bcdrooms~ F×i~lmg No Bedrooms New IllstaLlation [] <br /> <br /> 'l;c~t l lole~ Ready [] WiLl Call When Test Ilolc~ Ready [] <br /> l'umlT~orm AttacheA [] <br /> <br />5. Fee Schedules <br /> <br />IA NewOne-and-TwoFamil;,DwcllmgCode Valuathm: $ ....... <br /> (incluges El, Me, ¢1'} <br /> <br />(1)Sq Ft--. x 28 <br />(2) 5% Slate Surcharge (,05 x Al) <br />(3) Base Fee for Plan Rewew <br />(4) 7~::mmg Surcharge (ff Applicable) <br /> <br />Subtotal. $ <br /> <br />I85.00 <br /> <br /> El, Mc, I'1 am ~epamte penntt~ ) Yaluation: <br /> <br /> (1) permit ~'e¢ <br /> (2) 5% Sram Surcharge (05 x <br /> <br /> (4) Plans Check ( 65 x B1) <br /> Suh/otah: $_~ <br /> <br />C Septic Fee~ 0nclu~s DEQ Surcharge) (1) SAte Evaluation <br /> (2) Ne~ Septtc ~ta~ation Pe~it <br /> (3) Auzh~tttm Notice <br /> (4) ~xB*mg Sy~mm Report <br /> (5) Maj~ Re.ir <br /> Minor Repair (rank <br /> <br />D <br /> <br />(1) Drive.ay ',~/curb @ $750 <br />(2) Dmeway w/0 curh ~ $17 00 <br />(3) Si~ Plan Review (cmmercial onl)) @ <br />(4) kwestigatt~ <br />(5) Re[n~pectxon Fee ~ $2500 <br /> <br />Receipt:: <br /> <br /> <br />