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F~R OFFIC~ US, E'0NLY ~ MARION COUNTY BUILDING iNSPECTION <br />~Rec¢ivegt By: !//~ ,,,< , 220 High Street NE <br /> <br /> ' ....... <br /> BU~D~G PERM~ APPLICATION <br /> CO~L~ ~L SECTIONS, 1 ~OUG~ 4 <br /> <br />2. Location oflnstallatlon <br /> <br />Mobile Hom~ Park Space # <br /> ' ~ PfivamWcll ( ) Sp~g ( ) <br />~wlgm ~.. / g~m /~ , a~s ~.~t comer ~mpa~yW~( ) City (,~- <br /> <br />]ff ! hi~ subcontractors, I will hire only subcontractor~ registered with the Co~stmO. lon Contractors Board. ~f I change my mind and do Nrc a general contractor, I will contracl <br />with a contractor who is registered withe Construction Conceactoes Board, and will J.ramediacely notify Ma~on Coant~ of the name of the contractor <br /> <br /> ( ) I am a regis~:md builder OR thr authorized mpr~s~ntatlve of a registered builder, <br />ArcMtoctname: ,,~ ~..~ ~,~,t...~,.,.. IMa/llngAddress: <br /> <br />I Phone: <br /> <br />4. Fee Schedule <br /> <br />A. VALUATION ($~ "Valaatio~ $cheAula" <br /> <br /> (1) permit Fee <br /> <br /> (2) $% State Surcharge 005 x A 1 ) <br /> <br /> (3) Stmctur~ Plan R~vicw (.~% x Al) <br /> <br /> (4) Fi~ & Hfa Safety Plan Review (,~% x Al) <br /> (5) ~mng Surcha~e, if applicable (,05% x A I ) <br /> <br /> B. Misce.,llaneous Fe~s <br /> <br /> / a (1) Driveway w/curb @ $7,$0 <br /> Valuation: $~/ ~ <br /> / ~ O.~.~"D el) Driveway w/o curb @ $17.00 = ~.~ <br /> ~_ (3) .git~ Plan Review (eOmmer~al cg. ly) @ $79.00 -- <br /> L ~.,~ (4) AdditionalPlanRcviewsorAdd~mdums = -- <br /> = cs) v gation = __ <br /> = (6) Reinslx:~tioa I:'~ @ $25,00 = __ <br /> <br />MC 15-73 Rev, 11191 <br /> <br /> <br />