Laserfiche WebLink
FOR OFFICE USE ONLY [ MARION COUNTY BUI~_D(NG INSPECTION ]FOR OFFICE USE ONLY <br /> <br /> BUILDING PER MIT AI~I~I~I~I}JN ly /~_ <br />COMPLETE ALL SECTIONS, I THROUGH 4 BUILDING INSP£C'FiON <br /> <br />1. Job Description <br /> <br />RESIDFeaN'~AL COMMERCIAL ( ) New Use of Structure: <br /> <br />T~ (~ or Rafm~ ( ) ' ] No. Stories / ] Occu~nt Lind or Number of ~ploy~cs 1No. 8ed,'oom*: ' <br /> <br />Location of Installation <br /> <br />SobAddmss ~" t~/tOec. TaxA¢¢t. No.,~d~_~,~{~ CrossStreel ~ ~ <br />A= vedt ..... , .............. <br />Stlbthvision I.~ Bilk <br /> <br />Scctlon ~ ' ~Bwn,hlp ~ - _~ange ~ ~ Z~c'~, d Map Water Supply: <br />I.Ot Wklth F~q L~ Depth ¢00, Acre, Irreg. Imt ~S Comer~ C°m~uoil--:'Ze~Pdvate Well ())Spring(}Cily (~' <br /> <br />3. Contractor Information <br /> <br /> ( ) I owu, msid* Jrt, or will residg in the completed ~tmctum. <br /> <br /> ( ) I 0nderstand that I must register a~ a comtmetion contractor ff the structure is sold or offered for sale before or UlXm completion. <br /> ( ~ will be my own general contractor <br /> <br />( ~[ am a registered builder OR the authodz~zd representative of a rcgismred b0ilder. <br /> <br />Mailing Address: ] Phone: <br /> <br />4, Fee Schedule <br /> <br />A, VALUATION (See "Valuation Schedule" <br /> <br /> to determine valuatio{l based on <br /> <br /> (l) Pennlt <br /> <br /> (2) 5% State Surcharge (.05 x Al) <br /> <br /> (3) Sm,¢nxra[ Phn Rgview (.65% x A 1) <br /> <br /> (4) Fire & I.il'e SM~Iy Plan Review (.~% x Al) <br /> <br />(2) Driveway w/o curb @ $17.00 <br /> <br />(3) Site Plan Re¼ew (commercbl only) (0 $79,~×) <br /> <br />(4) Additional Plan Reviews or Addcmthms <br /> <br />(5) Invcstlgaticm Fcc <br /> <br />(6) Reinspecdon Fee@ $25.00 <br /> <br />(7) Other Inspections not listed above <br /> <br />'ro'I.XL s /5//?. 5"/ <br /> <br />x amc of Applicant (I lease 1 tint /¥l O. ~r } ~ J~. .~' ~. ~_'C'I ~,e' Phone: <br />Sign lurcofApplicant: [ ~ ~ '~'~~ __ Da:e: <br /> <br />MC 15-73 Rev, 11/91 <br /> <br /> <br />