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FOR OFFIC~ USE ON~L~ <br />Z~ning Valida~on/: <br /> .7'- f3 <br /> <br /> MARION COUNTY BUILDIN~I~i2T, iOaN I FOR OFFICE USE ONLY | <br /> <br /> BU~D~G PERM~ APP~{~0UNrF <br /> <br />Job Description <br /> <br />RE$1DF2¢TIAL COMMERCIAL ( )New <br />( ) Addition ( ) Relocation ()Addition ()Sign <br />( )Alteratlotl ( )DemoI½tiO~ ( )Alteration ()Dernolition <br />Square Feet: Bas,mint: I Main Fleer: ,, I"~'~omi mo*r: .... I Omev: .... ] Holgbt: ..... <br /> <br />2, Location of installation <br /> <br />3, C ontr actor Information <br /> <br />Mailing Add.ss { Phone No: <br /> <br />1~ I hi~ subcontractor% I will hire only subeontra,tors mgistet~ with the Construction ContraetOm Beard, If I change my mind and do hixo a general contractor, I will Contract <br />with a contractor who i~ m~4stemd w~the Construction C~traeto,f s Board, and will {mmedlatdy notify Marion County of the name of the contractor. <br />ContractorBusinessname&#: ~ ~ ,~t~'"td..~.~ [MailingAddt~ss: IPhone, <br /> <br />( ) f am a ~egistared builder OR the authorized repreaematlve of a registered bulkier, <br /> <br />Arehit~t name: I Mailing Address: t Phon~: <br /> <br />4. Fee Schedule <br />"'i 'VA[UAno~ (s~e "Va~jii& Schedule" <br /> <br />B. Miscdhneous Fees <br /> <br />1o determine Valuation based on <br /> <br />aquam footage.) <br /> <br />(1) Permit Fee <br /> <br />(2) 5% State Surcba~ge 605 x Al) <br /> <br />(3) Stractu~l Plan Review (,65% x Al) <br /> <br />(4) F/re & Dfc Safety Plan Review (.4Oqo x Al) <br />($). Y,.*,~ i,,-~'-~, ,. h .¥ ~., ;£ app2cablc (,;5% x A i') <br /> <br />V,l,ation, s <br /> <br /> (1) Drlveway w/curb @ $7,50 <br /> (2) Driveway w/o curb @ $17.00 <br /> O) Site Plan Rcv~ew (commercial only) @ $79.00 <br /> (4) Additional Plan Reviews or A4denduras <br /> (5) I~vesfigafic~ Fee <br /> (6) Relnspectlon Fe~@ $25.~0 <br /> (7) Other Inspections not listed above = <br />'~ RECEIPT: ] ~ ~ TOTAL $ ~. q2~q <br /> <br /> hereby ~ertify ~ai the above information is correct and that I have mad and understand the Information Notice to Property Owners about Constmctlorl Respons b titles on the <br /> <br />NameofAppic, ant0'lea~jM~t) Z.~ ~ ~ rT).J-I .g t~. ~ (~t, e~-7 ,r~t 79~ .... <br /> / /_. , ,--, ,, ph;.c:£Y -YYSV <br />Slgnamr¢ofApplieant:~ er-~ ~ D,te: q- ~- 77 <br />MC 15-?$ Rev. 11/9I <br /> <br /> <br />