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"FOR OFFICE USE ONLY <br /> Rc¢clved By: , <br />[ Zoning validation: <br /> Date: <br /> <br /> COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br /> 1. Job Description <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> <br /> $:00am - 4:30pnl Phone 588-5147 <br /> Code-A-Phone 588-7904 <br /> <br /> BUILDING PERMIT APPLICATION <br /> MAHION COUNTY <br /> <br /> FOR OFFICE USE ONLY <br />· City Setback Reqttitements: <br /> <br />RESIDENTIAL COMMERCIAL ( )New Use of Structare: <br /> <br /> ( )Addillon ( )Reloeatkal ( )Addition ( )Sign ~.rg, a.,3 <br /> ( ) Alteration ( )Demolitkm ( )Alteration ( )Demolition <br /> (/YdAceezsoiy ( )Other ( )ChmageofOccupancy ( )Other <br /> <br />o ri .o o Wo*m ................. <br />Tress( ) ot Rafter( ) I No. Stories [Oceupa~tLoadorNunabaro~Employees I No. Bedrooeas: <br />Squar~ Fect.~OO Basomcnt: I Main Floor: I Se4xmd Floor: I Other: { Height: / el <br /> <br />2. Location of Installation <br /> <br />TownsMp Range ~e Map Wamr Su~ly; <br /> .................. Private WeU ( ) Spring ( ) <br />Lot ~pth ~ q ~ Ams I~g. ~t Comer Community Wen ( ) City ~,, <br /> <br />3. Contraetor Information <br />Propmy Owner ~St,~Ac~ ~. ~ <br /> <br />( ) I will ba my own general eontraetor. <br /> <br />If ! hire subcontractors, I will hli~ only subcontraetow registered with the Construction Cc~tractors Beerd. If I change my mind and do Nrc a general contractor, I will contract <br />with ~ contractor who is registered withe Construction Cc~ttaetor'~ Board, md will immediately notify Marion Conmy of the name of the contractor. <br /> <br /> ~I am a t~gisteiml btdlder OR ~c authorlz~d rep~sml~t;ve of a i~gisasied builder, t <br /> <br />4. Fee Schedule <br /> <br />A. VALUA'I~ON (See '+Valuation Schedule" <br /> to determine valuation based on <br /> ~qua~e footage.) <br /> (1) F'ermit Fee <br /> <br /> ~2) 5% State Surcharge (,OS x Al) <br /> <br /> (3) Structural Plan Review (.65qo x A1 ) <br /> <br /> (d) Fi= & Life Safety Plan Review (.40% x A:l) <br /> (5) Zoning Surcharge, ff applleable (.05% x A 1) <br /> <br />B. Miscellaneous Fees <br />(1) Driveway w/¢ueo @ $7,50 = <br />(~) Driveway w/o curb ~ <br />O) Sim Plan R~ew (c~mer~al ~ly) ~ $79.~ <br />(4) Addifi~al Plan Renews or Add~d~s <br />(5) ~vesfiga~ Fee <br />(6) Rms~eri~ Fee ~ $2S,00 = __ <br />~) O~er ~s~efi~s not listed above = <br /> <br />Name of Appl~am (Please Print)'. <br /> <br /> S,,e evaluations, septic, ele~ea,, pSumbin~ me~han,cal wot, ~qu;2 se~r, te pe~its. <br />MC 15-'73 Rev. 11/91 <br /> <br /> <br />