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FOR OFF/CE USF~ONLY <br />' ] Zoning Validation' ~2~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />220 High Street NE <br /> <br />~-A-~o~ 588-79~ <br /> <br />;FOR OFFIC~"'USE ONLY <br /> <br />l'¢ftSide: /~5 ~ Right Side:/ <br /> <br /> BUILDING PERMIT APPLICATION <br /> ~AtlJON ~,OU~TY <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br /> 1. Job Description <br /> <br />2. Location of Installation <br /> <br />Subdivision ' Bioek <br />Mob~iomeF,~,, ~, t"'"'C~,~vK ~,~ ,, ~ ~D ....... ,,,. <br />Scion To~s~p Range Z~e Map Water <br /> ~4 rfivateWelt ( ) Spd~g ( ) <br /> <br />3, Contractor Information <br />P,~O~,~ m.~c3,~_~. Afleq }~a~g*dd~ 23~ Be.l[e~ I'~°~s°: ~-~0 <br /> ~) I ~si~e ~ mdde ~ the <br /> <br />4. Fee Schedule <br /> <br />A, VAiLUATION (Se~ "Valuation Schedule" <br /> <br /> to deteimi~e valuation baaed on <br /> <br /> (2) 5% State Sumha~e (.05 X A 1) = <br /> ~ S~mcmmr Plan Review (,65% x Al) <br /> (4) Fire & ~fe Safegy Plaa ~eview <br /> (5) ~ning Sumha~e, if a~cable (.05% x Al) = <br /> <br />I hereby ¢¢rtlfy that the above in/ormatlon is correct and that I have read and undcratand the Information Notice to Property Owners about Construction ResponsibflJties on thc <br />reverse si<l~ol' th[~ form. /~ /r~ , <br /> <br />MC 15-73 Rev. 11/91 <br /> <br />B- Mi~cellmeoUS Fees (1) Driveway w/¢tlrb@ <br /> <br /> (~) ~dveway w/o curb ~ <br /> <br /> (3) Sile Phn Renew (emmemhl rely) <br /> <br /> (4) Additional Plan Review~ or A~dmdms <br /> <br /> (5) ~vesfiga~on Fcc <br /> <br /> (6) Rm~cfim Fee ~ $25.00 <br /> ~) O~er~s~ct~s not HSt~ above <br />~c~t~ Z~4,,,~ <br /> <br />TOTal. s ?/' J"'~ <br /> <br /> <br />