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omc vs . ONL¥I <br />Received ily: J~/;Z~ 4 <br />Zoning Vo. li.datiO"?~ I <br /> <br />COMI~I~ ~L SECT~NS, 1 THROUGH 4 <br /> <br />1. Job ~cription <br /> <br /> (~New S~ngle F~ily Dwelling w/g~g~ <br /> ( ) New Single Family Dwelling w/o gmge <br /> <br /> / <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 220 High Street Nh; <br /> <br /> $:00am.4:30pm Phone 588-5147 <br /> Code-A-Phone 588-7904 <br /> FAX $88-7948 <br /> <br />ONE & TWO FAMILY DWELLING PERMrf APPLICATION <br /> <br />~Y <br /> <br /> ( ) Garage. detached <br /> <br />No. Stories / I Detached Garage Height: <br /> <br />MARION COUNTY <br />BUILDING INSPECTION <br /> <br />No. Bedrc~mq: ~ <br /> <br />O[her ~ <br /> <br />2. L~ation of lnstallatlon ~J&a~ <br /> <br /> ............ PdvateWell ( ) Spring <br />~Width ~ t b~De~ /~d t Acres ~eg.~t ~ (l~n*r ~ CommunltyWell( ) City <br /> <br />Contractor Information <br /> <br /> ) I own, reside in, c~ will ~*slde in the completed structure. <br /> <br /> ) i will be my own general coatractor. <br /> <br />If I hire subcontr~tor$. I will hire only subcontractors registered with the Constnlction Contractors Board. If I chang* my ntind and do )fire a general conlract c~ <br />who is registered with the ConstRiction Connactor's lloard, I will imnlodiately notify Marion County of tile. llatne of tim contra¢or: <br /> <br /> ~'/'q'a m a registorod builder OR the ~nthoriz~d representative of a r*gist~rod builder. <br />Architactname, ~?~Z ~..~ .,z~j~..~- [MallingAddres,, <br /> <br />[Phone: <br /> <br />4. Fee Schedule <br />A, New One-and. Two Fatnily Dwelling Code <br /> (inlcud~.q El. M~, PI) <br /> <br />(1l <;r,-,,Sq..rt. /q l O x$.28 <br />(2) $% State Surcharge (.05 x A'I) <br /> <br />(3) Plan Review <br /> <br />(4) Zoning Surcharge ($15 if applicable) <br /> <br />Valuation: $~ <br /> <br />B. Miscellaneous Fees <br /> <br /> (I) Drive.way w/curb t~ $7.50 <br /> <br /> (2) Driveway w/o t:urb @ $17.00 <br /> <br /> (3) Additional Plan Rt~vlews or Addendum~ <br /> (4) Investigation Fee <br /> <br /> (5) Reinspect/on Fee @ $25.00 <br /> <br /> (6) Other In,~peetJons not listed above <br />RECEIPT: <br /> <br /> I hereby certify thai tha ahove i~d-ormatJon i~ eorre~et and that I h~i:~c [¢a~_and unders nod fle Inf~ ~ on N~ce to ~y Owners n~t Construction Responsibilities on the <br /> ...... <br /> <br /> . ~- , · ~w ,, ~ Date: <br /> Sit~ ~valuafion~, septic, el*cttZal, plumbing and mechanical work req~re serrate ~rmits. Check wi~ M~on County Buliding Ins~ction ~fore sub~t~ng thi~ ~plicathm. <br />MC 15-80 Rev. 1~2 <br /> <br /> <br />