Laserfiche WebLink
[FO.R;, OrHIC ? LYI MARION COUNTY BUILDING INSPECTION FOR OFFICE, USE ONLY <br /> ReceDed By' .~ ! g ~ ~ 220 High Street NE - <br />,.· <br />[Da~: I .j . 8:~-a:B~Ph~e588-51~ Lift 8id~ <br /> F~ 588-7948 <br /> BU~D~G PERM~ APPLICATION <br /> COMTE ~L SECTIONS, 1 T~OUOH 4 MARION COUNTY <br /> I. Job Description BUI~ING INSPECTION <br /> <br />R]8$.~DENTIA L COMMERCIAL ( )New Use of Structure: <br />( ) Alteration ( )Dmolifion ( )AlmraQotl ( )D~mol;fion <br />( )Acccsso~ ( )Other ( )C'hanscofOccupancy <br /> <br />2, Location of Installation ~Z~,~'~wr~ M <br /> <br />P~j~-tty Owner I Mailing Addrcss I Phone No: <br /> <br /> own, rcslde i~, or will reside in thc completed structure. <br />I und~r~tand that I met r~gister as a constmetim ¢onuaetor If the structure is sold or offered for sale before or Ul:)on completion' <br /> will b~ my own gee:al cent meter, <br /> <br />If I h~ subcontractors, I will him only subcontractors registered with th~ Construction Contractors Board. K I change my mind and do hire a general contractor, I wi[[ contract <br />v~th a contractor who is registered wlthe Construction Contm¢~of~ Board, and will immediately notify Marion County of the name of the cOntractor. <br />ContraetorSusinessnamea#; ~, /{_ ~i I '"O~l~f~ ' ~'~G Mail/ngAddrczw <br /> ..... g ... ~ ~ l, [ ...... ' 7~5 ~q~ ~l~met-/ }Phone: '7'77--/5'0 CD <br /> (,) Iam are.g,!s[e~dbuJlderOR theautho~,,cd mpmsen~tiveofamgiatercdbttil0er. <br /> <br />4. ~'ee Schedule <br />A. VALUATION(See ';'Valuation Schedule" B. MiseclIaaeous Fees <br /> <br />to determine valuation based ~1 <br />square footage.) Valuation: <br /> <br />(2) 5% Sram Surcha~e 605 x Al) <br />(~) Structural Plm Rev~w $65% x Al) <br /> <br />(4) Fire & ~fc Safety Plan Review (.~% x A I <br /> <br />(11 Driveway w/curb @ $7.50 <br /> <br />(2) D~veway w/o ctlrb @ <br /> <br />(3) $1t~ Plan R~view (commercial only) <br /> <br />(4) Addkional Plan Reviews or A~dendums <br /> <br />(5) Investigation Fee <br /> <br />(6) Rcin~pect~on Fee @ $25.00 <br />(7) Other ~q:~e.~d~s no~ lis ted abo-,,e <br /> <br />i hereby ¢¢1~ iJ'y that thc above irfformafion is correct arid that I have mad and I)ndcr~tand the hlfonnatJon Notice o Property Owners about Construction Responsibilities on the <br />reverse side of this form. ' ' - <br /> <br /> '~1'. ,, . ~ . / __ , j j ,,, 1 none: ,~ ,, ~ ~ <br /> <br /> Sitg ~vlthlafioni, septic, el¢c~fical, plumbing and mechanical wo~q~ ~e~rate ~mits. Ch=ok wi~ Mari~ County gullding Inspeainn ~fom ~u~ittmg ~i'~app~cafion. <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />